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Chapter 33 - Acute Pain Management in the ICU

Published online by Cambridge University Press:  24 May 2023

Alan David Kaye
Louisiana State University School of Medicine
Richard D. Urman
Brigham and Women’s Hospital, Boston
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Pain in the critically ill patient is often underreported and misdiagnosed. Contributing factors include such patients not being able to express themselves due to invasive respiratory support or altered mental function. Pain management in the intensive care unit (ICU) can be challenging due to the severity of illness of critically ill patients. The benefits and risks of pain management techniques and medications should be weighed against the severity of the patient’s illness and their comorbidities, as well as the side effects of each technique and medication.

Publisher: Cambridge University Press
Print publication year: 2023

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Further Reading

Kaushal, B, Chauhan, S, Saini, K, et al. Comparison of the efficacy of ultrasound-guided serratus anterior plane block, pectoral nerves II block, and intercostal nerve block for the management of postoperative thoracotomy pain after pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33(2):418–25.CrossRefGoogle ScholarPubMed
Yalamuri, S, Klinger, RY, Bullock, WM, Glower, DD, Bottiger, BA, Gadsden, JC. Pectoral fascial (PECS) I and II blocks as rescue analgesia in a patient undergoing minimally invasive cardiac surgery. Reg Anesth Pain Med. 2017;42(6):764–6.Google Scholar
Fujii, S, Roche, M, Jones, PM, Vissa, D, Bainbridge, D, Zhou, JR. Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study. Reg Anesth Pain Med. 2019;44(5):556–60.Google ScholarPubMed
Krishna, SN, Chauhan, S, Bhoi, D, et al. Bilateral erector spinae plane block for acute post-surgical pain in adult cardiac surgical patients: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2018;33(2):368–75.Google ScholarPubMed
Alford, DP, Compton, P, Samet, JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144(2):127–34. [Published correction appears in: Ann Intern Med. 2006;144(6):460.]CrossRefGoogle ScholarPubMed
Weibel, S, Jelting, Y, Afshari, A, et al. Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour. Cochrane Database Syst Rev. 2017;4(4):CD011989.Google Scholar
Budd, K. The role of tramadol in acute pain management. Acute Pain. 1999;2(4):189–96.Google Scholar
Ho, KY, Gwee, KA, Cheng, YK, Yoon, KH, Hee, HT, Omar, AR. Nonsteroidal anti-inflammatory drugs in chronic pain: implications of new data for clinical practice. J Pain Res. 2018;11:1937–48.Google Scholar
Schwenk, ES, Viscusi, ER, Buvanendran, A, et al. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):456–66.Google Scholar
Dunn, LK, Durieux, ME. Perioperative use of intravenous lidocaine. Anesthesiology. 2017;126(4):729–37.CrossRefGoogle ScholarPubMed
Jung, S, Ottestad, E, Aggarwal, A, Flood, P, Nikitenko, V. 982: Intravenous lidocaine infusion for management of pain in the intensive care unit. Crit Care Med. 2020;48(1):470. Available from: Scholar
Habibi, V, Kiabi, FH, Sharifi, H. The effect of dexmedetomidine on the acute pain after cardiothoracic surgeries: a systematic review. Braz J Cardiovasc Surg. 2018;33(4):404–17.Google Scholar

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