Analgesia In Intensive Care Research Articles

Analgesia in intensive care: part 2

### Key points Pain is a common cause of distress in the intensive care unit (ICU) and a vast majority of patients experience it at some point during their stay. Systemic analgesia, most notably opioids, remains the mainstay in its management. However, opioids are associated with significant side-effects like delirium, ileus, respiratory depression, and increased duration of mechanical ventilation, especially when used as continuous prolonged infusions.1 There has been a general trend in ICU to move towards targeted analgesia and avoidance of sedation. In the ICU, regional anaesthesia (RA) when indicated has the potential to offer excellent pain relief but avoiding the unwanted side-effects of opioids. Unlike the perioperative setting, its role in the ICU has not been thoroughly evaluated. However, the potential benefits offered by RA can be significant and extend beyond just provision of analgesia (Table 1). Despite its numerous advantages, RA remains an underutilized modality, due to various challenges and perceived disadvantages (Table 1). View this table: Table 1 Advantages and disadvantages of RA in intensive care The objective of this article …

Analgesia in intensive care: part 1

### Key points Patients in intensive care experience distress because of a multitude of factors and a significant proportion is attributable to pain.1 A vast majority of patients report moderate to severe pain at some point during their intensive care stay. Pain can be caused or provoked by many pre-existing conditions: acute medical, surgical, or routine aspects of intensive care (Table 1). View this table: Table 1 Causes of pain in intensive care. SCI, spinal cord injuries; GBS, Guillain-Barre syndrome; MS, multiple sclerosis Pain is widely regarded as the fifth vital sign, and it induces a myriad of deleterious physiological changes in most organ systems. Severe pain induces a stress response and sympatho-adrenergic stimulation causing tachycardia, hypertension, increased myocardial oxygen consumption, and can induce myocardial ischaemia in susceptible patients. Poorly managed pain from abdominal incisions reduces diaphragmatic function, causes hyperventilation and atelectasis. Pain especially in sedated patients can present as agitation, delirium and when badly managed can have psychological sequelae like post-traumatic stress disorder,2 depression, and anxiety or it can progress to chronic pain. Systemic deleterious effects of pain include systemic inflammatory response syndrome, hyperglycaemia, immunosuppression, impaired wound healing, hypercoagulability, and increased catabolism. All these detrimental effects can …

Sedation and Analgesia in Intensive Care: A Comparison of Fentanyl and Remifentanil

Optimal sedation and analgesia are of key importance in intensive care. The aim of this study was to assess the quality of sedoanalgesia and outcome parameters in regimens containing midazolam and either fentanyl or remifentanil. A prospective, randomized, open-label, controlled trial was carried out in the ICU unit of a large teaching hospital in Istanbul over a 9-month period. Thirty-four patients were randomly allocated to receive either a remifentanil-midazolam regimen (R group, n = 17) or a fentanyl-midazolam regimen (F group, n = 17). A strong correlation between Riker Sedation-Agitation Scale (SAS) and Ramsey Scale (RS) measurements was observed. Comparatively, remifentanil provided significantly more potent and rapid analgesia based on Behavioral-Physiological Scale (BPS) measurements and a statistically nonsignificantly shorter time to discharge. On the other hand, remifentanil also caused a significantly sharper fall in heart rate within the first six hours of treatment.

Epidural analgesia in intensive care: Our experience

Epidural analgesia in intensive care: Our experience

Sedation and analgesia in intensive care (with the exception of new-born babies)

Sedation and analgesia in intensive care (with the exception of new-born babies)

Sedation and analgesia in intensive care

PREVIEWSedation and analgesia are often used in critical care patients to alleviate pain, anxiety, and the stress response. These techniques are not interchangeable, but their effects can be synergistic. Occasionally, neuromuscular blockade is necessary. In this article, Dr Blanchard discusses indications for sedation, analgesia, and neuromuscular blockade, as well as monitoring techniques and adverse effects.

Lumbar epidural analgesia in intensive care of myocardial infarction patients with recurrent pain syndrome

Lumbar epidural analgesia in intensive care of myocardial infarction patients with recurrent pain syndrome

Lumbar epidural analgesia in intensive care of myocardial infarction patients with recurrent pain syndrome

Lumbar epidural analgesia in intensive care of myocardial infarction patients with recurrent pain syndrome