The Internet Book of Critical Care Podcast IBCC Episode 96 - Analgesia for the critically ill patient
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Aug 28, 2020 Exploring multimodal approaches to analgesia in critically ill patients, including the use of ketamine, alpha-2 agonists, and opioids. Discussion on challenges with opioid infusions, NSAIDs, and optimizing dosing for lidocaine. Emphasis on developing comprehensive analgesic plans to improve patient outcomes.
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Multimodal Analgesia Is Superior
- Multimodal analgesia uses multiple low-dose drugs to gain synergistic pain relief while minimizing toxicity.
- This approach replaces the old reflex of escalating opioids alone and reduces side effects from any single high-dose agent.
Follow A Ladder: Start Low, Add Modalities
- Start the analgesic ladder with acetaminophen and escalate through adjuvants before defaulting to opioid infusions.
- Reserve continuous sedative opioid infusions as a last resort and prefer stepwise multimodal additions.
Use Scheduled Acetaminophen As Baseline
- Give acetaminophen regularly (e.g., 650–1000 mg q6h) as a foundation for ICU analgesia when not contraindicated.
- Use IV, PR, or PO routes when enteral access is unavailable and reduce dose in chronic liver disease to ≤2 g/day.