5. Critical Care Analgesia Flashcards
List causes of pain in ICU
Acute -> Chronic
- Surgical Incision
Trauma - Organ dysfxn
- GI Ischaemia / PE DVT / Cardiac ischaemia - Pre existing - neuropathies / arthritis / malignancy
- Pressure Sores / Wounds / Join pain / Contractures
- Chronic pain conditions myopathy
- Procedures
dressings / turning / cannula / suction - Pressure sores / wounds / joint pains / contractures + Immobility
Adverse effects pain
- CVS
Sympathetic drive / Hr BP / Myocardial o2 demand increase - ischaemia / infarction
2. Respiratory atelectasis increase o2 consumption VQ mm impaired gas exch
- GI
Urinary retention = agitation
Adverse effects of Pain
- Endocrine
Stress response
aldosterone + ADH
Sodium and water retention - Haem
Risk venous stasis
DVT/PE
Adverse effects of Pain
- MSK
Immobility =
critical illness polyneuropathy + Myopathy
7. Neuropsychological Sleep deprivation Agitation delirium increased PTSD
Increased ICU stay
Methods of Analgesia
Paracetamol
Opioids
Other Agents
Regional
Paracetamol
Simple analgesic
Antipyretic
IV infusion
PO / NG /PR
Evidence reduced op requirement
Opioid
Morphine Fentanyl
Practice changing
Other agents
Clon
Clonidine a2 agonist rx delirium & htn also S/E CVS depression gut motility
**dexmedetomidine
** SSRIS - duloxetine
Ketamine
Phencyclidine derivative
Excellent analgesic properties
procedures - dressing changes
Sedation and RX sev asthma & COPD exacerbation
S/E - CVS stim nausea vomiting secretions delerium
Neuropathic analgesics
TCA / Gabapentin / Pregabalin
Pre admission for those with
long standing neuropathic continued
NSAID
Opioid sparing
s/e profile
renal
gi uler
Regional
Epidural post op / flail chest
standard risks
Cathterrs
Alternative
Tens / Arompatherapy
No evidence
but should not be withheld
