Abstract
Since critically ill patients frequently cannot report their own level of discomfort, watching for signs of pain becomes an important task for the ICU clinician. Opioids are the mainstay of pharmacologic pain relief, and morphine, fentanyl and hydromorphone (where available) are preferred agents. Mixed agonist-antagonist agents are less useful, and meperidine (pethidine) has significant disadvantages in the critically ill population. Opioids may be administered intermittently, by continuous infusions and patient-controlled pumps, and, in selected patients, via the epidural route, where opioids may be augmented with local anesthetics. Tolerance and withdrawal symptoms must be considered , and a weaning process is recommended for patients receiving opioids for more than 72 hours. Non-steroidal agents and acetaminophen are adjuncts to opioids for pain relief, but must be used cautiously in the elderly and patients at risk for organ system failure.
Clinical Intensive Care 2003, 14 (3–4): 91–98
Clinical Intensive Care 2003, 14 (3–4): 91–98