Supervisors info:
Άντεια Παρασκευά, Κααθηγήτρια ,Ιατρική Σχολή, ΕΚΠΑ
Αικατερίνη Αμανίτη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΑΠΘ
Αικατερίνη Μελεμενή, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Opioids are one of the most common drugs administered to critically ill patients for pain management and as an adjunctive sedation drug. The result of the exposure of these patients to high concentrations of opioids is the occurrence of adverse effects with serious consequences.
Purpose: To minimize the use of opioids in critically ill patients, by administering adjuvant drugs or non-pharmacological interventions.
Method: Twenty-one studies (Ν:7894), at the period of 2016-2023, included interventions on the use of opioids, in a population of adult critically ill patients in the intensive care unit. The pharmacological implemented interventions are the following: acetaminophen, ketamine, lidocaine, tramadol, dexmedetomidine, gabapentin, sevoflurane, melatonin as well as the application of regional anesthesia. The non-pharmacological interventions that implemented are a pain protocol, pupil diameter measurement index, transcutaneous electrical nerve stimulation and music therapy.
Results: Fourteenth of the 21 studies, corresponding to 44,82% (N:3538) had a positive outcome in the intervention applied to them to reduce opioids, while in seven with a percentage of 55,18% (N:4356), there was no difference in opioid use. Specifically, in 6 (N:321) to 7 studies (N:483) of ketamine, the studies of: acetaminophen (N:68), paracetamol in combination with tramadol (N:50), lidocaine (N:21), melatonin (N:56), intrathecal administration of morphine (N:70), as well as the application of: continuous regional nerve block (N:76), transcutaneous nerve stimulation (N:50), and a pain protocol (N:2826), had a positive outcome in opioid restriction. While one study of ketamine (N:162), the studies of: dexmedetomidine (N:3904), gabapentin (N:40), sevoflurane (N:79), intercostal nerve block (N:80), pupillary diameter index (N:50), and music therapy (N:41) had a negative outcome.
Conclusion: Pharmacological and non-pharmacological interventions such as administration of acetaminophen, lidocaine, melatonin, subarachnoid morphine, regional nerve block or stimulation, application of pain protocols, may be able to limit opioid use in critically ill intensive care unit patients.
Keywords:
Critical illness, Critical patients, Pain management in intensive care unit, Opioid complications, Adjuvant analgesic agents .
