IBCC Episode 96 - Analgesia for the critically ill patient

The podcast addresses the pervasive issue of pain management in critical care, advocating for a shift towards multimodal analgesia to minimize reliance on opioids. It highlights the difficulty of diagnosing pain versus agitation in critically ill patients and the limited evidentiary basis for many common practices. The discussion emphasizes the importance of a tiered approach, starting with acetaminophen and progressing cautiously through options like ketamine and alpha-2 agonists before resorting to opioid infusions. The hosts caution against the overuse of opioid infusions due to rapid tolerance, dependence, and potential for hyperalgesia, advocating instead for bolus-only strategies and aggressive weaning protocols. They also explore the judicious use of NSAIDs, lidocaine, and gabapentinoids, while underscoring the value of non-pharmacological interventions like early mobility and physical therapy.