Key result
Multimodal analgesia incorporating nonopioid analgesics in critically ill patients enables patient comfort and opioid-sparing effects, though their use requires careful individual assessment.
Why the study?
Long-term ICU opioid therapy carries significant risks, but the use of nonopioid analgesics such as NSAIDs remains controversial due to potential organ toxicities in critically ill patients.
Multimodal analgesia incorporating nonopioids can reduce opioid reliance in the ICU, but must be carefully tailored due to risks of renal injury and bleeding in critically ill patients.
Cautious multimodal nonopioid analgesia may aid opioid sparing in ICU; leaves open optimal regimens pending prospective trials.
Patients in intensive care units (ICUs) experience pain, which they describe as a significant cause of stress during treatment. It can progress to chronic pain and significantly affect the quality of life. Opioids have long been the backbone of ICU pain therapy. The consequences of their long-term use are known today, such as prolonged ICU stay and mechanical ventilation, resulting in increased treatment costs. Additionally, abstinence syndrome is a consequence of abrupt opioid withdrawal. Also, there is a risk of tolerance and hyperalgesia after prolonged opioid use. Globally, opioid dependence after hospital opioid treatment is alarming, although there is still a lack of data on its incidence after ICU. Multimodal analgesia enables comfort to the patient, opioid-sparing, and avoidance of side effects of non-opioid analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a broad group of drugs recommended with paracetamol to treat mild to moderate acute postoperative pain. Although often prescribed by intensivists, their use in treating painful conditions in ICU is controversial due to the possible consequences on the organs of critically ill patients. Due to the inhibition of cyclooxygenases, NSAIDs indirectly cause vasoconstriction of the renal arteries and arterioles, leading to kidney damage. NSAIDs inhibit platelet aggregation and may predispose to bleeding. Analgesia of a critically ill patient is a important part of their treatment, however it can be challenging in certain patients. Numerous combinations of pharmacological and non-pharmacological approaches can be adapted to the patient's current characteristics.
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Orović et al. (2022) conducted a review in Pain in critically ill patients. Nonopioid analgesics vs. Opioids (historical/general context) was evaluated. Multimodal analgesia incorporating nonopioid analgesics in critically ill patients enables patient comfort and opioid-sparing effects, though their use requires careful individual assessment.
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