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Semin Respir Crit Care Med 2001; 22(2): 127-136
DOI: 10.1055/s-2001-13827
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Pain in the Intensive Care Unit: Recognition, Measurement, Management

K. David Sanders, Philip McArdle, John D. Lang Jr.
  • Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

There has been a resurgence in interest in the in-hospital management of pain, largely related to results of investigations into the role of analgesia in outcome and cost-efficiency. The traditional aim of analgesia as simply an altruistic goal has been supplanted by the goal of impacting on the altered physiology accompanying critical illness and trauma. Elucidation of the effect of pain and the accompanying stress response on pulmonary dysfunction in particular, but also on myocardial ischemia and coagulation, has suggested that the provision of adequate analgesia by time-honored methods may not in itself effect a reduction in morbidity without attention to the method of analgesic delivery and choice of agent.

KEYWORD

Analgesia - pulmonary dysfunction - myocardial ischemia

REFERENCES

  • 1 Donovan M, Dillion P, McGuire L. Incidence and characteristics of pain in a sample of medical-surgical patients.  Pain . 1987;  30 69-78
    CrossrefPubMedGoogle Scholar
  • 2 Desbiens N, Wu A, Broste S. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations.  Crit Care Med . 1996;  24 1953-1961
    PubMedGoogle Scholar
  • 3 Dray A. Inflammatory mediators of pain.  Br J Anaesth . 1995;  75 125-131
    PubMedGoogle Scholar
  • 4 Jensen M P, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods.  Pain . 1986;  27 117-126
    CrossrefPubMedGoogle Scholar
  • 5 Habibi S, Coursin D. Assessment of sedation, analgesia and neuromuscular blockade in the perioperative period.  Int Anesthesiol Clin . 1996;  34 215-241
    PubMedGoogle Scholar
  • 6 Larson M, Sessler D, Washington D. Pupillary response to noxious stimulation during isoflurane and propofol anesthesia.  Anesth Analg . 1993;  76 1072-1078
    PubMedGoogle Scholar
  • 7 Terai T, Yukioka H, Asada A. Pain evaluation in the intensive care unit.  Reg Anesth Pain Med . 1998;  23 147-151
    PubMedGoogle Scholar
  • 8 Breslow M J. Clinical implications of the stress response to surgery. In: Longnecker DE, Tinker JH, Morgan GE, eds. Principles and practice of anesthesiology 2nd ed. St. Louis, MO: Mosby Year Book 1998: 117-129
    Google Scholar
  • 9 Michelson D, Gold P, Sternberg E. The stress response in critical illness.  New Horiz . 1994;  2 426-431
    PubMedGoogle Scholar
  • 10 Pflug A, Halter J. Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans.  Anesthesiology . 1981;  55 120-126
    PubMedGoogle Scholar
  • 11 Kehlet H. The modifying effect of general and regional anesthesia on the endocrine-metabolic response to surgery.  Reg Anesth . 1982;  7 S38
    PubMedGoogle Scholar
  • 12 Kehlet H. The stress response to anesthesia: release mechanisms and modifying factors.  Clinics in Anesthesiology . 1984;  2 315
    PubMedGoogle Scholar
  • 13 Weissman C. The metabolic response to stress: an overview and update.  Anesthesiology . 1990;  73 308-327
    PubMedGoogle Scholar
  • 14 Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation.  Br J Anaesth . 1997;  78 606-617
    CrossrefPubMedGoogle Scholar
  • 15 Moller I, Dinesan K, Sondergard S. Effect of patient-controlled analgesia on plasma catecholamine, cortisol and glucose concentrations after cholecystectomy.  Br J Anaesth . 1988;  61 160-164
    PubMedGoogle Scholar
  • 16 Brodner G, Pogatzki E, Aken H. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy.  Anesth Analg . 1998;  86 228-234
    PubMedGoogle Scholar
  • 17 Grass J. The role of epidural anesthesia and analgesia in postoperative outcome.  Anesthesiology Clinics of North America . 2000;  18 407-428
    CrossrefPubMedGoogle Scholar
  • 18 Rosenfeld B, Beattie C, Christopherson R. The effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis.  Anesthesiology . 1993;  79 435-443
    PubMedGoogle Scholar
  • 19 Cook P, Davies M, Cronin D. A prospective randomized trial comparing spinal anesthesia using hyperbaric cinchocaine with general anesthesia for lower limb vascular surgery.  Anaesth Intensive Care . 1986;  14 373-380
    PubMedGoogle Scholar
  • 20 Christopherson R, Beattie C, Frank S. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery.  Anesthesiology . 1993;  79 422-434
    PubMedGoogle Scholar
  • 21 Mangano D T, Siliciano D, Hollenberg M. Postoperative myocardial ischemia: therapeutic trials using intensive analgesia following surgery.  Anesthesiology . 1992;  76 342-353
    CrossrefPubMedGoogle Scholar
  • 22 Vanhoutte P M, Shimokawa H. Endothelium-derived relaxing factor and coronary vasospasm.  Circulation . 1989;  80 1-9
    PubMedGoogle Scholar
  • 23 Davis R, DeBoer L WV, Maroko P R. Thoracic epidural analgesia reduces myocardial infarct size after coronary artery occlusion in dogs.  Anesth Analg . 1986;  65 711-717
    PubMedGoogle Scholar
  • 24 Bonnet F, Blery C, Zatan M. Effect of epidural morphine on postoperative pulmonary dysfunction.  Acta Anaesthesiol Scand . 1984;  28 147-151
    PubMedGoogle Scholar
  • 25 Shulman M, Sandler A, Bradley J. Postthoracotomy pain and pulmonary function following epidural and systemic morphine.  Anesthesiology . 1984;  61 569-575
    CrossrefPubMedGoogle Scholar
  • 26 Benhamou D, Samii K, Noviant Y. Effect of analgesia on respiratory muscle function after upper abdominal surgery.  Acta Anaesthesiol Scand . 1983;  27 22-25
    PubMedGoogle Scholar
  • 27 Cicala R, Voeller G, Fox T. Epidural analgesia in thoracic trauma: effects of lumbar morphine and thoracic bupivacaine on pulmonary function.  Crit Care Med . 1990;  18 229-231
    PubMedGoogle Scholar
  • 28 Buck M, Blumer J. Opioids and other analgesics.  Crit Care Clin . 1991;  7 615-637
    PubMedGoogle Scholar
  • 29 Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit.  Crit Care Clin . 1995;  11 827-847
    PubMedGoogle Scholar
  • 30 Catley D M, Thornton C, Jordon C. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen.  Anesthesiology . 1985;  63 20-28
    CrossrefPubMedGoogle Scholar
  • 31 Gislason T, Almqvist M, Boman G. Increased CSF opioid activity in sleep apnea syndrome.  Chest . 1989;  96 250
    CrossrefPubMedGoogle Scholar
  • 32 Reeder M K, Muir A D, Foex P. Postoperative myocardial ischaemia: temporal association with nocturnal hypoxaemia.  Br J Anaesth . 1991;  67 626-631
    PubMedGoogle Scholar
  • 33 Shapiro B,Warren J, Egol A. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary.  Crit Care Med . 1995;  23 1596-1600
    CrossrefPubMedGoogle Scholar
  • 34 Brill J. Control of pain.  Crit Care Clin . 1992;  8 203-218
    PubMedGoogle Scholar
  • 35 Anand K, Arnold J. Opioid tolerance and dependence in infants and children.  Crit Care Med . 1994;  22 334-342
    PubMedGoogle Scholar
  • 36 Lee A, Cooper M, Crain J. The effects of nonsteroidal antiinflammatory drugs on postoperative renal function: a metaanalysis.  Anaesth Intensive Care . 1999;  27 574-580
    PubMedGoogle Scholar
  • 37 Kroll W, List W. Pain treatment in the ICU: intravenous, regional or both?.  Eur J Anaesthesiol . 1997;  14 49-52
    PubMedGoogle Scholar
  • 38 Myles P, Buckland M, Cannon G. Comparison of patient-controlled analgesia and nurse-controlled infusion analgesia after cardiac surgery.  Anaesth Intensive Care . 1994;  22 672-678
    PubMedGoogle Scholar
  • 39 Searle N, Roy M, Bergeron G. Hydromorphone patient-controlled analgesia after coronary artery bypass surgery.  Can J Anaesth . 1994;  41 198-205
    PubMedGoogle Scholar
  • 40 Kane R E. Neurologic deficits following epidural or spinal anesthesia.  Anesth Analg . 1981;  60 150
    PubMedGoogle Scholar
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