Regional analgesia techniques for pain management in patients admitted to the intensive care unit

Rubio-Haro, Ruben; Morales-Sarabia, Javier; Ferrer-Gomez, Carolina; Andrés, José De

doi:10.23736/s0375-9393.19.13447-5

Cited by 11 publications

(6 citation statements)

References 70 publications

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“…Many of the strategies discussed herein for inpatient postoperative patients may also be applied to various special populations, including trauma/emergent surgical patients, the elderly, the obese, obstetric populations, and pediatrics, as discussed in more detail elsewhere [293,300,[365][366][367][368][369][370][371][372][373][374][375][376][377].…”

Section: Postoperative Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Postoperative Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…Regional and neuraxial analgesia, where local anesthetics are used to provide targeted inhibition of pain propagation, are optimal techniques for treating pain and reducing opioid consumption in patients where indicated. There is substantial evidence that regional analgesia is superior to systemic analgesia; however, regional techniques remain underused in ICU settings 107 . Regional anesthesia, in the form of epidurals, paravertebral catheters, and erector spinae blocks, have been extensively examined in patients with rib fractures and multitrauma 108–113 .…”

Section: Nonopioid Analgesia For Acute Pain Managementmentioning

confidence: 99%

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Smith

Wang

Abdukalikov

et al. 2022

The Journal of Clinical Pharma

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The opioid epidemic has resulted in increased opioid‐related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short‐acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity.

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“…In regional analgesia, opioids are administered into the epidural or subarachnoid spaces of the spinal cord. Pruritus occurs in almost 50% of patients who receive intrathecal opioids [9]. Regional analgesia with opioids is also indicated for patients in intensive care units because they provide superior pain control and have fewer side effects than systemic treatment [10].…”

Section: Mechanism Of Action Of Opioidsmentioning

confidence: 99%

“…W znieczuleniu miejscowym opioidy podawane są do przestrzeni zewnątrzoponowych lub podpajęczynówkowych rdzenia kręgowego. Świąd występuje u prawie 50% pacjentów, którzy otrzymywali opioidy dooponowo [9]. Znieczulenie miejscowe z zastosowaniem opioidów jest również wskazane w przypadku chorych przebywających na oddziałach intensywnej terapii, ponieważ zapewnia ono lepszą kontrolę bólu i ma mniej działań niepożądanych niż leczenie ogólnoustrojowe [10].…”

Section: Wskazania Do Stosowania Opioidówunclassified

Opioids in clinical practice

Zaporowska-Stachowiak

Oduah

Celichowska

et al. 2020

Palliat Med Pract

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The treatment of pain improves quality of life. Opioids are commonly prescribed painkillers. The side effects of opioids depend on the route of administration, dosage, drug metabolism, comorbid diseases and the patient's general condition. Despite many beneficial effects, opioids can lead to increased mortality in heart failure, myocardial infarction, pulmonary oedema, and COPD. This article reviews specific uses of opioid medications. Opioids induce immunosuppression, and may undergo drug-drug interactions, especially during polytherapy or polypragmasia.

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Regional analgesia techniques for pain management in patients admitted to the intensive care unit

Cited by 11 publications

References 70 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Opioids in clinical practice

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