Regional anesthesia for management of acute pain in the intensive care unit

Abstract

Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids’ side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects.

Plasma concentrations of alpha-1-acid glycoprotein in preterm and term newborns: influence of mode of delivery and implications for plasma protein binding of local anaesthetics

“…14e16 The trend in adult postoperative care is moving away from routine use of opioids for various reasons. 17,18 Regional anaesthetic techniques are now used in children 2 and can be used even in extremely preterm infants. 19 However, unintentional overdosing, inadvertent intravascular administration, or excessive absorption of LAs from the injection site may cause serious side-effects (e.g.…”

Dibucaine in Ionic-Gradient Liposomes: Biophysical, Toxicological, and Activity Characterization

“…Adequate postsurgical pain management is critical for patient rehabilitation 1 . The infiltrative administration of local anaesthetics into the surgical site can achieve temporary analgesia, but bupivacaine and other long-acting agents provide no more than 7 hours of anaesthesia.…”

“…Pain management is still an on-going issue, especially in intensive care units. 1 Moderate to severe postoperative pain was experienced by many patients who underwent orthopaedic, maxillofacial, breast, inguinal hernia, or varicose vein surgeries, amongst others. 2 The use of local anaesthetic (LA) wound infiltration for postoperative analgesia has been demonstrated to be a highly effective pain control technique.…”

Efficacy and safety of multimodal analgesic techniques for preventing chronic postsurgery pain under different surgical categories: a meta-analysis

“…Regional analgesia has been clearly shown to be effective in reducing postsurgery pain, and has been associated with less adverse effects than opioids 11–14 . In addition, regional anesthesia, such as epidurals, are used in procedures involving specific wound entry sites.…”