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Sedation and Analgesia in ICU

Analgesics used in ICU

The same modes of analgesia are available and used in ICU as elsewhere, but with some important considerations.

 

Non-pharmacological methods:

  • Are important, often very simple ways of reducing patient discomfort.

  • Include:

    • The proper positioning of patients (including the stabilisation of fractures)

    • Comfortable temperature

    • Adequate hydration, bowel and bladder care

    • Physiotherapy, patient activity and regular turning

    • Removing unpleasant physical stimulation (e.g. traction on tubes/drain, lying on lines/connectors)

    • TENS, heat/cold therapy, massage, music

Systemic drug therapy:

  • Paracetamol

    • Used to treat mild pain or in combination with opioids to treat moderate to severe pain.

    • Dose reduction (to 15mg/kg q.i.d.) or increased dosing intervals (6 hourly) may be required in some patients (cachexia/malnourished, alcoholic, impaired hepatic function, renal impairment (creatinine clearance < 30ml/min)) because of the higher risk of hepatotoxicty.

    • Avoidance or administration on an as required basis rather than regularly in patients with suspected infections to avoid masking pyrexias.

  • Opioids

    • Form the mainstay of analgesia in ICU.

    • Please see next page.

  • Non-steroidal anti-inflammatory drugs (NSAIDs)

    • Their side-effects of impaired renal, platelet and gastric protective function severely restrict their use in ICU.

    • Same advice whenever used: use as low a dose for as short a period of time as possible.

 

Regional anaesthesia/analgesia:

  • Is used safely in ICU.

  • Can form a key component of managing patients with multiple rib fractures and patients with major co-morbidities who have undergone chest, abdominal or limb surgery/instrumentation.

  • Must be carefully considered in terms of risk/benefit because of the potential higher risks (infection, bleeding and haematomas) associated with its use.

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