Management of procedural pain in the intensive care unit

Table 2 The management of pain caused by establishing different vascular access

Operational type	Ref.	Drugs	Advantages	Disadvantages
Arterial puncture and catheterization	Zeng et al[11], 2007	Subanesthetic dose of ketamine (0.5 mg/kg) combined with midazolam (0.05 mg/kg)	The effect of pain management is 100%, with less side effect on breathing and circulation	Older and infirm should pay attention to transient respiratory depression
	Rüsch et al[14], 2017	Vapocoolant sprays	Can replace lidocaine to relieve discomfort caused by arterial catheterization	Not mentioned
	Ruetzler et al[13], 2012	Lidocaine/tetracaine patch	Effectively relieve pain	Need enough time before operation
PICC	Fry and Aholt[15], 2001	Buffered lidocaine	Effectively relieve pain	With short-term stability
CVC	Vardon Bounes et al[18], 2019	Remifentanil combined with lidocaine	Effectively relieve pain and has a short half-life	Extended operating time
	Samantaray et al[17], 2016	Fentanyl	Effectively relieve pain, less adverse respiratory and cardiovascular events	It is not as good as dexmedetomidine in providing comfort to patients
	Samantaray and Rao[16], 2014	Fentanyl	Effectively relieve pain	Respiratory depression may occur
ECMO	Maybauer et al[21], 2019	Ketamine	Provides relatively stable hemodynamic stability while maintaining airway reflex	There may be dose-related hallucinations, paralysis, tearing, tachycardia, and possibly increased intracranial pressure, and coronary ischemia
	Floroff et al[20], 2016	Ketamine	Less respiratory depression, better pain control, boosting, and increased cardiac output	There may be dose-related hallucinations, sputum, hooliganism
	Tellor et al[19], 2015	Ketamine	Can reduce the amount of opioids used in surgical patients	The safety and efficacy of patients requiring ECMO therapy have not been determined

PICC: Peripherally inserted central catheter; CVC: Central venous catheter; ECMO: Extracorporeal membrane oxygenation.