Opioids in the ICU

Abstract

  Opioids are the most commonly used and effective analgesics administered in intensive care units (ICU) . In ICU patients, effective analgesia may prevent myocardial ischemia and pulmonary complications. Since ICU nurses often underestimate the degree of pain being experienced by a patient and they may administer inadequate doses of analgesics by misguided fears of adverse effects or addiction, education on pain management and analgesia for ICU nurses and the accurate assessment of pain are therefore very important. Pain assessment using a numeric rating scale or the observer-reported face scale is practical in the ICU. During ventilator treatment, pain may be assessed by pain-related behavior and physiological indicators (blood pressure, heart rate) , although pain evaluation is very difficult. In patients undergoing mechanical ventilation, sedation assessment using the Ramsay Scale, Sedation-Agitation Scale or the Richmond Agitation-Sedation Scale is also useful. Opioid administration techniques in the ICU include intramuscular, intravenous and epidural techniques. Epidural opioids are extremely advantageous because of their longer duration of analgesia and lower incidences of both mental status changes and agitation compared with systemic administration of opioids, although epidural analgesia is sometimes contraindicated in critically ill patients. An epidural opioid combined with epidural local anesthetics is more commonly used than an epidural opioid alone. During ventilator treatment, continuous intravenous administration of propofol or midazolam should be performed in addition to opioid administration. Adequate pain relief without adverse effects through the correct use of opioids is needed for ICU patients.