Analysis of Pain Management in Critically Ill Patients

Abstract

We analyzed the adequacy of pain control for 17 trauma patients during the initial part of their stay in the intensive care unit, and assessed reasons for inadequate analgesia, if it occurred. Patients, and physicians, and nurses were interviewed. A verbal pain intensity scale was used to determine whether patients received adequate analgesia. Patients were asked if the pain hindered their activities, and whether they requested pain medication from their caregivers. Caregivers were questioned whether patients received adequate analgesia. Prescribed morphine regimens and the amount of narcotic administered were analyzed. Twenty-seven percent of patients rated pain intensity as moderate and 47% as severe. Ninety-five percent of housestaff and 81% of nurses reported the patients received adequate pain control. Forty-seven percent of the patients who had moderate or severe pain asked their physician for more pain medication, and 65% asked the nurse. Thirteen residents did not order a larger dose of morphine due to concern about respiratory depression or hypotension. Morphine dosages ranged from 1-8 mg intravenously every 1-2 hours as necessary. Nurses administered less than the maximum amount ordered 58% of the time. The mean dosing interval was 2.3 hours. Barriers to adequate pain management were disparity in the perception of pain between patients and caregivers; patients not requesting more analgesia despite despite the presence of moderate to severe pain; and physician and nurse concerns about patients' adverse physiologic response to increased dosages.

A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients

“…Firstly, whereas previous studies in this field have chosen sedation scores or duration of mechanical variation as the primary outcome variable, we chose validated pain scores. It is well known from previous studies that caregivers underestimate pain in the ICU [4,21]. Our approach was novel in that we used only validated, patient-determined pain scores.…”

Behavioral Pain Assessment Tool for Critically Ill Adults Unable to Self-Report Pain

“…Each domain is scored from 0 to 2, with a maximum score of 8. The tool has content validity, moderate to high interrater reliability, discriminate validity, and moderate criterion S tudies [1][2][3][4][5] on recall of moderate to severe pain challenge the effectiveness of pain management during an intensive care unit (ICU) stay. Patients' inability to selfreport pain is a marked barrier to effective assessment and management of pain.…”

Analgesic treatment in patients with acute extremity trauma and effect of training

“…[10,19,22] Yapılan çalışmalarda yaşlı popülasyonun analjezi uygulama yetersizliği açısından risk altında olduğunu belirtmesine karşın bizim çalışmamızda diğer çalışmalardan farklı olarak eğitim öncesi dönemde 39 yaş altı gruptaki hastalara daha az analjezi uygulandığı tespit edildi.…”

“…[5,7,8] Yetersiz analjezi uygulama nedenleri araştırıldığında opioid kullanımına bağlı yan etkilerin ortaya çıkma korkusu, bağımlılık oluşturma kaygısı ve diğer analjeziklerle ilgili yetersiz eğiti-min de eşlik ettiği saptanmıştır. [9,10] Yetersiz analjezi (oligoanaljezi) için risk taşıyan hasta grupları özellikle çocuklar ve yaşlı hastalar, erkekler, bazı etnik gruplar, apse drenajı, kırık redüksiyonu gibi ağrılı tedavi yöntem-leri uygulananlar hastalar ve acil servisten eve taburcu edilen hastalardır. [10][11][12][13][14][15] Bu çalışmada amaç, üniversite acil servisine akut ağrı ile baş-vuran erişkin ekstremite travmalı hastalarda acil tıp asistanlarının analjezi uygulama davranışlarını saptamak ve eğitim-le kısa dönemde nasıl ve ne boyutta etkilendiğini araştır-maktır.…”