Pain Control in the Intensive Care Unit

  • S. Brett
  • U. Waheed
Conference paper

Abstract

Analgesia is defined as the absence of sensibility to pain or noxious stimuli in the conscious patient. Patients admitted to the intensive care unit (ICU) commonly have pain and physical discomfort from a number of factors, which include pre existing disease, invasive procedures, and trauma. Pain and discomfort can also be caused by monitoring, routine nursing care (airway suctioning, physiotherapy, patient mobilization and dressing changes) and therapeutic devices such as drains, non-invasive ventilation, and endotracheal tubes. Inadequate analgesia can contribute to inadequate sleep leading to exhaustion, disorientation and agitation. Pain evokes a stress response characterized by tachycardia, increased myocardial oxygen consumption, hypercoagulability, immunosuppression, and persistent catabolism [1]. Poorly controlled analgesia may be associated with pulmonary dysfunction due to guarding of muscles around areas of pain leading to restrictive movements of the chest wall and diaphragm.

Keywords

Intensive Care Unit Intensive Care Unit Patient Intensive Care Unit Setting Verbal Rating Scale Acute Pain Management 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lewis KS, Whipple JK, Michael KA, Quebbeman EJ (1994) Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm 51: 1539–1554PubMedGoogle Scholar
  2. 2.
    Acute Pain Management Guideline Panel (1992) Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guideline. AHCPR Publication No. 920032. Agency For Health Care Policy and Research, RockvilleGoogle Scholar
  3. 3.
    Puntillo KA, Miaskowski C, Kehrle K, Stannard D, Gleeson S, Nye P (1997) Relationship between behavioral and physiological indicators of pain, critical care patients’ self reports of pain, and opioid administration. Crit Care Med 25: 1159–1166PubMedCrossRefGoogle Scholar
  4. 4.
    Christoph SB (1987) Pain assessment: The problem of pain in the critically ill patient. Crit Care Nurse Clin North Am 3: 11–16Google Scholar
  5. 5.
    Harrison M, Contach P (1987) Pain: Advances and issues in critical care. Crit Care Nurse Clin North Am 22: 691–697Google Scholar
  6. 6.
    Les D (1990) Monitoring pain control and charting. Crit Care Clinician 6: 283–294Google Scholar
  7. 7.
    Rawal N, Tandon B (1985) Epidural and intrathecal morphine in intensive care units. Intensive Care Med 11: 129–133PubMedCrossRefGoogle Scholar
  8. 8.
    Puntillo KA (1990) The pain experiences of intensive care unit patients. Heart Lung 19: 526–533PubMedGoogle Scholar
  9. 9.
    Ferguson J, Gilroy D, Puntillo K (1997) Dimensions of pain and analgesic administration associated with coronary artery bypass in an Australian intensive care unit. J Adv Nurs 26: 10654–10672Google Scholar
  10. 10.
    Byers JF, Smyth KA (1997) Effect of music intervention on noise annoyance, heart rate, and blood pressure in cardiac surgery patients. Am J Crit Care 6: 183–191PubMedGoogle Scholar
  11. 11.
    Chlan L (1998) Effectiveness of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory assistance. Heart Lung 27: 169–176PubMedCrossRefGoogle Scholar
  12. 12.
    Bonnet F, Kergrohen F, Lafosse JE, Loriferne JF, Salvat A, Debras C (1986) Postoperative rigidity after fentanyl administration. Eur J Anesthesiol 3: 413–416Google Scholar
  13. 13.
    McArdle P (1999) Intravenous analgesia. Crit Care Clin 15: 89–105PubMedCrossRefGoogle Scholar
  14. 14.
    Grossmann M, Abiose A, Tangphao 0, et al (1996) Morphine-induced venodilation in humans. Clin Pharmacol Ther 60: 554–560PubMedCrossRefGoogle Scholar
  15. 15.
    Flacke JW, Flacke WE, Bloor BC, Van Etten AP, Kripke BJ (1987) Histamine release by four narcotics: A double blind study in humans. Anaesth Analg 66: 723–730Google Scholar
  16. 16.
    Shapiro BA, Warren J, Egol AB, (1995) Practice parameters for intravenous for intravenous analgesia and sedation for adult patients in the intensive care unit: An executive summary. Crit Care Med 23: 1596–1600Google Scholar
  17. 17.
    Egan TD (1995) Remifentanil pharmakokinetics and pharmacodynamics. A preliminary appraisal. Clin Pharmakokinet 29: 80–94CrossRefGoogle Scholar
  18. 18.
    Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT (1993) Pharmakokinetics of remifentanil and its major metabolite in patients undergoing elective implant surgery. Anaesthesiology 79: 893–903CrossRefGoogle Scholar
  19. 19.
    Egan TD, Lemmens HJM, Fiset P, et al (1993) The pharmacokinetics of the new short-acting opioid remifentanil (g187084B) in healthy adult volunteers. Anesthesiology 79: 881–892PubMedCrossRefGoogle Scholar
  20. 20.
    Tipps LB, Coplin WM, Murry KR, et al (2000) Safety and feasibility of continuous infusion of remifentanil in the neurosurgical intensive care unit. Neurosurgery 46: 596–602PubMedCrossRefGoogle Scholar
  21. 21.
    Breen D, Wilmer A, Bodenham A, et al (2001) The offset of pharmacodynamic effects of remifentanil in ICU patients is not affected by renal impairment. Intensive Care Med 27: S207 (abst)Google Scholar
  22. 22.
    Albanese J, Viviand X, Potie F, Rey M, Alliez B, Martin C (1999) Sufentanil, fentanyl, alfentanil in head trauma patients: A study on cerebral hemodynamics. Crit Care Med 27: 407411Google Scholar
  23. 23.
    Jacobi J, Fraser GL, Coursin DB, et al (2002) Task force of the American college of critical care medicine (ACCM) of the society of critical care medicine (SCCM), American society of health-system pharmacists (ASHP), american college of chest physicians. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30: 119–141Google Scholar
  24. 24.
    Cammarano WB, Pittet JF, Weitz S, Schlobohm RM, Marks JD (1998) Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 26: 676–684PubMedCrossRefGoogle Scholar
  25. 25.
    Buck M, Blumer J (1991) Opioids and other analgesic: Adverse effects in the intensive care unit. Crit Care Clin 7: 615–637Google Scholar
  26. 26.
    Anand KJS, Ingraham J (1996) Tolerance, dependence, and strategies for compassionate withdrawal of analgesics and anxiolytics in the pediatric ICU. Crit Care Nurse 16: 87–93PubMedGoogle Scholar
  27. 27.
    Stokie IL (1992) Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 3rd edition. American Pain Society, Glenview.Google Scholar
  28. 28.
    Wall PD (1995) Inflammatory and neurogenic pain: new molecules, new mechanisms. Br J Anaesth 75: 123–124Google Scholar
  29. 29.
    Schlondorff D (1993) Renal complications of nonsteroidal anti-inflammatory drugs. Kidney Int 44: 643–653PubMedCrossRefGoogle Scholar
  30. 30.
    Feldman HI, Kinman JL, Berlin JA, et al (1997) Parenteral Ketorolac: The risk for acute renal failure. Ann Intern Med 126: 193–199Google Scholar
  31. 31.
    Clive DM, Stoff JS (1984) Renal, syndromes associated with nonsteroidal anti-inflammatory drugs. N Engl J Med 310: 563–572PubMedCrossRefGoogle Scholar
  32. 32.
    Warner TD, Giuliano F, Vojnovic I, et al (1999) Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. Proc Natl Acad Sci USA 96: 7563–7568PubMedCrossRefGoogle Scholar
  33. 33.
    Bombardier C, Laine L, Reicin A, et al (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR study group. N Engl J Med 343: 1520–1528Google Scholar
  34. 34.
    Silverstein FE, Faich G, Goldstein JL, et al (2000) Gastrointestinal toxicity with celecoxib versus non steroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. The CLASS study: A randomized control trial. JAMA 284: 1247–1255Google Scholar
  35. 35.
    Juni P, Rutjes A, Dieppe P (2002) Are selective COX 2 inhibitors superior to traditional non steroidal anti-inflammatory drugs?: Adequate analysis of the CLASS trial indicates that this may not be the case. Br Med J 324: 1287–1288Google Scholar
  36. 36.
    Cleland LG, James MJ, Stamp LK, Penglis PS (2001) COX-2 inhibition and thrombotic tendency: a need for surveillance. Med J Aust 175: 214–217PubMedGoogle Scholar
  37. 37.
    Mukherjee D, Nissen SE, Topol EJ (2001) Risk of cardiovascular events associated with selective cox-2 inhibitors. JAMA 286: 954–959PubMedCrossRefGoogle Scholar
  38. 38.
    Mackenzie IM, Forest K, Thompson F, et al (1999) Hypotension following acetaminophen administration to critically ill patents. Crit Care Med 27: 33a (abst)Google Scholar
  39. 39.
    Pedutta VA, Ballabio M, Stefanini S, et al (1998) Efficacy of propacetamol in the treatment of postoperative pain. Morphine sparing effect in orthopaedic surgery. Italian Collaboration Group on Proparacetamol. Acta Anaesthesiol Scand 42: 293–298Google Scholar
  40. 40.
    Schug SA, Sidebotham DA, McGuinnely M, et al (1998) Acetaminophen as an adjunct to morphine by PCA in the management of acute post-operative pain. Anaesth Analg 87: 368–372Google Scholar
  41. 41.
    Hylek EM, Heiman H, Skater SJ, Sheenan MA, Singer DE (1998) Acetaminophen and other risk factors for excessive warfarin anticoagulation. JAMA 279: 657–662PubMedCrossRefGoogle Scholar
  42. 42.
    Venn RN, Bradshaw CJ, Spencer R, et al (1989) Preliminary UK experience of dexmedetomidine, a novel agent for post operative sedation in the intensive care unit. Anaesthesia 54: 1136–1142CrossRefGoogle Scholar
  43. 43.
    Furst SR, Weinger MB (1990) Dexmedetomidine A selective alpha 2-agonist, does not potentiate the cardiorespiratory depression of alfentanil in the rat. Anaesthesiology 72: 882–888CrossRefGoogle Scholar
  44. 44.
    Gold MS, Redmond DE Jr, Kleber HD (1978) Clonidine blocks acute opiate-withdrawal symptoms. Lancet 2: 599–601PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • S. Brett
  • U. Waheed

There are no affiliations available

Personalised recommendations