Page 295 Guide to Pain Management in Low-Resource Settings

Chapter 37

Pain Management in the Intensive Care Unit

Josephine M. Th orp and Sabu James

Case report pain relief, disadvantages of excessive analgesics
or sedatives)
A 52-year-old man, Joe Blogg, was admitted to the in- • Assessment of pain and sedation
tensive care unit (ICU) from the operating room, after • Aims of therapy
undergoing a long surgical procedure. He had been the • Techniques of pain management (routes for phar-
driver of a car that was involved in a head-on collision, macological agents, analgesics, anxiolytics, and
and he was trapped in the car (no seat belt or air bag) local anesthetic techniques)
for about 30 minutes. When fi rst assessed in the receiv- • Adjuncts to pharmacological agents (managing
ing accident and emergency care unit, he was rousable the ICU environment, reducing other sources of
but confused and in considerable pain. His injuries discomfort, alternative measures, psychological
were as follows: measures)
Bilateral pneumothoraces (intercostal drains Th e majority of patients requiring intensive care
were inserted in the accident and emergency unit by the will suff er pain, of varying intensity, during their stay.
resuscitation team). Fractures of the third, fourth, and Despite knowledge since the early 1970s that pain is of-
fi fth ribs on the left side. Deep wounds to right knee and ten the worst memory for patients surviving intensive
right elbow, extending to the joint. An extensive mesen- care, in recent multicenter studies up to 64% of patients
teric tear, for which he underwent a 5-hour laparotomy. still said they were often in moderate to severe pain
Estimated blood loss of about 5 L, coagulopathic, with a while in the ICU. Th e experiences of patients who did
platelet count of 50,000 postoperatively. He had several not survive their ICU stay remain unknown. Patients
units of blood and blood components in the operating who were in ICU for longer periods reported greater in-
room. He is anuric and hypothermic (with a core tem- tensity of pain.
perature of 34°C).
He was transferred to the intensive care unit for What are the sources of pain?
elective ventilation and management. • Primary pathology, such as burns, traumatic inju-
ries, fractures, wounds (surgical or traumatic)
What issues must be considered in this case for • Complications of the original condition or new
intensive care and afterwards?
problems, such as bowel perforation or break-
• Sources of pain (exacerbating factors) down of bowel anastomosis causing peritonitis,
• Eff ects of untreated pain (advantages of adequate ischemic bowel, pancreatitis

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 283
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
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