Page 337 Acute Pain Management

(Pandey et al, 2005 Level II). IV lignocaine may be useful in the treatment of acute neuropathic
pain in Guillain‐Barre syndrome based on evidence of benefit in other neuropathic pain
disorders (Kalso et al, 1998 Level I).
Plasma exchange in acute Guillain‐Barre syndrome was associated with a shortened duration
of disease and improved outcomes, including pain (Guillain‐Barre Syndrome Study Group, 1985
Level II).
While steroid therapy is not advocated as primary management in postinfectious
polyneuropathy, it may provide rapid resolution of the severe backache associated with the
acute phase of the neuropathy (Kabore et al, 2004 Level IV).

9.8.5 Procedure-related pain
There is often an assumption that patients who are intubated and sedated in intensive care
will not recall or perceive pain during procedures. Lines and catheters are sometimes inserted
without supplementary anaesthesia. A survey suggests that specific treatment of procedure‐
related pain occurs less than 25% of the time (Payen et al, 2007 Level III‐1). Patients who have
memories of ICU, recall discomfort in 54% and overt pain in 12% (Payen et al, 2007 Level IV).
Endotracheal tube suctioning and other medical interventions are consistently reported as
being uncomfortable or painful.
In conclusion, adequate local and/or parenteral anaesthesia should be provided during any
noxious procedure (Puntillo et al, 2004).

Key messages
1. Daily interruptions of sedative infusions reduce duration of ventilation and ICU stay
without causing adverse psychological outcomes (U) (Level II) or increasing the risk of
myocardial ischaemia (N) (Level III‐1).
2. Gabapentin is more effective than carbamazepine in reducing the pain associated with
Guillain‐Barre syndrome (S) (Level II).

3. Remifentanil or remifentanil with morphine provides better analgesia than morphine alone
in ventilated intensive care unit patients (N) (Level II).
4. The use of formal pain and agitation assessment and subsequent treatment in ventilated
intensive care unit patients decreases the incidence of pain and duration of ventilation (N) CHAPTER 9
(Level III‐1).

The following tick box  represents conclusions based on clinical experience and expert
opinion.
 Observation of behavioural and physiological responses permits assessment of pain in
unconscious patients (U).
 Patients should be provided with appropriate sedation and analgesia during potentially
painful procedures (U).

Acute pain management: scientific evidence 289