Commonly Used Opioids in the Orthopedic Operating Room: A Narrative Review

Orthopedic surgical procedures are consistently associated with significant postoperative pain due to extensive tissue manipulation, osseous injury, and inflammatory responses. Effective perioperative analgesia is therefore fundamental to successful orthopedic outcomes, influencing early mobilization, complication rates, length of hospital stay, and patient satisfaction. Although opioid-sparing and enhanced recovery after surgery (ERAS) pathways have gained popularity, opioids remain central to analgesic management in orthopedic operating rooms. This narrative review examines the opioids most commonly used in orthopedic perioperative care, including fentanyl, morphine, remifentanil, hydromorphone, oxycodone, sufentanil, and methadone. Emphasis is placed on pharmacologic properties, clinical indications, dosing considerations, adverse effects, and comparative evidence in orthopedic populations. In addition, the evolving role of opioids within multimodal analgesia frameworks is discussed, with attention to balancing effective pain control against opioid-related risks.