Lazar Alexandra Elena, Butiulca Mihaela, Farczadi Lenard
George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania.
Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania.
J Crit Care Med (Targu Mures). 2024 Jul 31;10(3):198-208. doi: 10.2478/jccm-2024-0023. eCollection 2024 Jul.
Effective pain management is vital for critically ill patients, particularly post-surgery or trauma, as it can mitigate the stress response and positively influence morbidity and mortality rates. The suboptimal treatment of pain in Intensive Care Unit (ICU) patients is often due to a lack of education, apprehensions about side effects, and improper use of medications. Hence, the engagement of pain management and anesthesiology experts is often necessary. While opioids have been traditionally used in pain management, their side effects make them less appealing. Local anesthetics, typically used for anesthesia and analgesia in surgical procedures, have carved out a unique and crucial role in managing pain and other conditions in critically ill patients. This work aims to offer a comprehensive overview of the role, advantages, challenges, and evolving practices related to the use of local anesthetics in ICUs. The ability to administer local anesthetics continuously makes them a suitable choice for controlling pain in the upper and lower extremities, with fewer side effects. Epidural analgesia is likely the most used regional analgesic technique in the ICU setting. It is primarily indicated for major abdominal and thoracic surgeries, trauma, and oncology patients. However, it has contraindications and complications, so its use must be carefully weighed. Numerous challenges exist regarding critically ill patients, including renal and hepatic failure, sepsis, uremia, and the use of anticoagulation therapy, which affect the use of regional anesthesia for pain management. Appropriate timing and indication are crucial to maximizing the benefits of these methods. The advent of new technologies, such as ultrasonography, has improved the safety and effectiveness of neuraxial and peripheral nerve blocks, making them feasible options even for heavily sedated patients in ICUs.
有效的疼痛管理对重症患者至关重要，尤其是术后或创伤后的患者，因为它可以减轻应激反应，并对发病率和死亡率产生积极影响。重症监护病房（ICU）患者疼痛治疗不充分通常是由于缺乏相关知识、对副作用的担忧以及药物使用不当。因此，通常需要疼痛管理和麻醉学专家的参与。虽然传统上阿片类药物一直用于疼痛管理，但其副作用使其吸引力降低。局部麻醉药通常用于手术中的麻醉和镇痛，在管理重症患者的疼痛和其他病症方面发挥了独特而关键的作用。这项工作旨在全面概述局部麻醉药在ICU中的作用、优势、挑战以及不断发展的应用实践。持续给予局部麻醉药的能力使其成为控制上肢和下肢疼痛的合适选择，且副作用较少。硬膜外镇痛可能是ICU中最常用的区域镇痛技术。它主要适用于大型腹部和胸部手术、创伤以及肿瘤患者。然而，它有禁忌症和并发症，因此其使用必须谨慎权衡。对于重症患者存在许多挑战，包括肾衰竭、肝功能衰竭、败血症、尿毒症以及抗凝治疗的使用，这些都会影响区域麻醉在疼痛管理中的应用。合适的时机和适应症对于最大化这些方法的益处至关重要。新技术的出现，如超声检查，提高了神经轴和周围神经阻滞的安全性和有效性，使其即使对于ICU中深度镇静的患者也是可行的选择。
