PAIN TREATMENT IN THE ICU - INTRAVENOUS, REGIONAL OR BOTH

Adequate treatment of pain in ICU patients should be an integral part of ICU management, as inadequately treated pain leads to a series of c omplications that may counteract the success of ICU treatment. For con tinuous intravenous use we recommend sufentanil in a dose of 0.75-1.0 mu g kg(-1) h(-1) in mechanically ventilated patients and in a dose of 0.25-0.35 mu g kg(-1) h(-1) in intubated and spontaneously breathing patients. On-demand analgesia, administered via the intravenous or epi dural route, may be an alternative to a relatively fixed continuous in fusion of an analgesic drug, and in some ICU patients the transdermal use of opioids can be an alternative to continuous intravenous drug ap plication or PCA. Increased sizes of the patch (25, 50, 75, 100 cm(2)) provide sustained transdermal rates of approximately 25, 50, 75 and 1 00 mu g h(-1) of fentanyl over a period up to about 72 hours. Patients with trauma to the thorax, pelvic fracture, or after major surgical i nterventions will be better managed by regional application of analges ic drugs alone or in combination with a systemic analgesic drug infusi on. To achieve the best results it is necessary to be well informed an d trained in the method, to know the advantages and disadvantages, the correct and modified dosages of the drugs used, and the indications a nd contraindications.