Analgesics
Morphine is the agent most commonly used in ICU. For severe renal impairment, ie. eGFR <30ml/min, fentanyl should be used. Pethidine is not to be used without prior discussion with the intensivist on duty.
Ketamine may also be considered as an adjunct to opiates.
Antineuropathic agents, such as pregabalin and amitryptilline, should be considered in the presence of neuropathic pain.
Paracetamol - do not prescribe regular intravenous paracetamol unless authorised by the Duty Consultant.
Consider input from the Acute Pain Management Team for advice if pain is difficult to control or consideration of regional blocks, eg. epidurals or intercostal blocks. For patients with end-of-life considerations, input from the Palliative Medicine team is also valuable, especially for intractable pain and anxiety.
See also, Epidural Management Protocol (PROMPT) - includes information on trouble-shooting and timing of antithrombotics.
Ketamine may also be considered as an adjunct to opiates.
Antineuropathic agents, such as pregabalin and amitryptilline, should be considered in the presence of neuropathic pain.
Paracetamol - do not prescribe regular intravenous paracetamol unless authorised by the Duty Consultant.
- Oral or enteral paracetamol is absorbed in the stomach, so is effective in patients who are “nil by mouth” or have an ileus.
- Each time an intravenous line is accessed, the risk of a line infection increases
- Intravenous paracetamol is much more expensive than oral / enteral paracetamol, and is no more effective if the patient has a working GIT.
Consider input from the Acute Pain Management Team for advice if pain is difficult to control or consideration of regional blocks, eg. epidurals or intercostal blocks. For patients with end-of-life considerations, input from the Palliative Medicine team is also valuable, especially for intractable pain and anxiety.
See also, Epidural Management Protocol (PROMPT) - includes information on trouble-shooting and timing of antithrombotics.