BJA Education: Analgesia in intensive care: part 2 (Read) for Medical Doctors

Permission has been granted by Elsevier on behalf of the British Journal of Anaesthesia to link directly to articles and MCQs from BJA Education on e-Learning Anaesthesia.

Key points

• Pain is a common problem in intensive care; region- al anaesthesia (RA), although less studied, offers ex- cellent pain relief while avoiding opioid-induced side-effects.
• Performance of RA in intensive care is fraught with challenges. The pharmacology of local anaesthetics (LAs) is greatly influenced by pathophysiological states common in this setting, and understanding this is important in minimizing the complications.
• Despite numerous dilemmas like sepsis, coagulopa- thy, inotrope dependence, and sedation, risk–benefits of RA have to be considered on an individual basis and the reasons clearly documented.
• In intensive care, a high index of suspicion and close monitoring is necessary to promptly identify the de- velopment of neuraxial infections or LA toxicity.
• The risk due to RA can be minimized by adopting local and national guidelines, using modern tech- nologies, and considering available alternatives and local expertise.