Stamenkovic Dusica M, Laycock Helen, Karanikolas Menelaos, Ladjevic Nebojsa Gojko, Neskovic Vojislava, Bantel Carsten
Department of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia.
Medical Faculty, University of Defense, Belgrade, Serbia.
Front Pharmacol. 2019 Feb 22;10:23. doi: 10.3389/fphar.2019.00023. eCollection 2019.
Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33-73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.
在重症监护病房（ICU）接受治疗的患者中，近一半经历中度至重度疼痛。对危重症患者进行疼痛管理具有挑战性，因为他们的疼痛原因复杂多样。药物治疗通常侧重于阿片类药物，在长时间住院期间，这可能意味着高累积剂量，存在出院时阿片类药物依赖的风险。尽管进行了镇痛，但ICU治疗后慢性疼痛的发生率仍很高，范围在33%至73%之间。需要采取措施防止从急性疼痛转变为慢性疼痛，同时避免阿片类药物的过度使用。这篇叙述性综述讨论了ICU患者慢性疼痛发生的预防措施。它考虑了一些可以采用的策略，包括非阿片类镇痛药、区域镇痛和非药物方法。我们认为，个性化的疼痛管理计划应成为危重症患者的基石，以促进其从重症监护和医院出院后的身心健康。
