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Acute pain management in intensive care
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) (Level III‐1). SUMMARY
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 in emergency departments
Migraine
1. Triptans or phenothiazines (prochlorperazine, chlorpromazine) are effective in at least
75% of patients presenting to the emergency department with migraine (U) (Level II).
Local anaesthesia
2. Topical local anaesthetic agents (including those in liposomal formulations) (N) (Level I)
or topical local anaesthetic‐adrenaline agents (N) (Level II) provide effective analgesia for
wound care in the emergency department.
3. Femoral nerve blocks in combination with intravenous opioids are superior to
intravenous opioids alone in the treatment of pain from a fractured neck of femur (S)
(Level II).
To ensure optimal management of acute pain, emergency departments should adopt
systems to ensure adequate assessment of pain, provision of timely and appropriate
analgesia, frequent monitoring and reassessment of pain (U).
Prehospital analgesia
1. Intravenous morphine, fentanyl and tramadol are equally effective in the prehospital
setting (N) (Level II).
2. Nitrous oxide is an effective analgesic agent in prehospital situations (N) (Level IV).
3. Methoxyflurane, in low concentrations, may be an effective analgesia in the hospital and
prehospital setting (N) (Level IV).
4. Ketamine provides effective analgesia in the prehospital setting (N) (Level IV).
5. Moderate to severe pain is common in both adult and paediatric patients in the
prehospital setting (N) (Level IV).
Acute pain management: scientific evidence xli
