Role of regional analgesic techniques in ICU

Abstract

Pain is a major problem in patients admitted in the Intensive Care Units (ICU). Untreated pain has significant impact on the outcome of these patients, especially surgical patients. There is enough evidence in the literature which has demonstrated that inadequately treated pain in ICU leads to prolonged ventilation, longer ICU stay, morbidity and other issues like development of post-traumatic stress disorder (PTSD) and chronic post-surgical pain (CPSP). Regional anesthesia and analgesia (RA) techniques like epidural analgesia, paravertebral blocks, and other peripheral nerve blocks (PNB) play a great role in providing significant pain relief, thus, limiting the use of opioids. They facilitate in earlier weaning from ventilation, reducing respiratory morbidity, and faster rehabilitation. These RA techniques are most useful in polytrauma patients, major thoracoabdominal and orthopedic surgeries, as many of them require post-surgical ICU care. However, these RA techniques are underutilised in many ICUs. Many a times, ICU physicians are not well versed with these RA techniques, and sometimes have fixed misconceptions with regards to these blocks. In this review, we will discuss on the need of these RA techniques and make a quick presentation on the technical aspect of frequently used blocks. The review will only focus on Ultrasound-guided regional analgesia (USRA) techniques as USG is commonly available in ICUs.
Abbreviations: PTSD (Post-traumatic stress disorder), CPSP (Chronic post-surgical pain), RA (Regional anesthesia and analgesia), USRA Ultrasound-guided regional analgesia), PNB (Peripheral nerve block), IFPB (Interfascial plane blocks), ASRA (American Society of Regional Anesthesia and Pain Medicine)
Citation: Sahoo RK, Nair AS, Badole UR, Kar R, Jadon A. Role of regional analgesic techniques in ICU. Anaesth Pain & Intensiv Care 2018;22 Suppl 1:S73-S82