Management of procedural pain in the intensive care unit

Table 1 Classification of procedural pain in the intensive care unit

Category	Specific operation
Establishment of vascular access	Arterial puncture and catheterization	Peripherally inserted central catheters	Central venous catheter	Extracorporeal membrane oxygenation	Continuous renal replacement therapy etc.
Natural cavity noninvasive catheterization	Endotracheal intubation	Bronchofiberscopy	Nasogastric tube intubation	Nasal jejunal intubation	Urethral catheterization etc.
Natural cavity percutaneous catheterization and extubation	Pericardiocentesis	Thoracentesis	Thoracic closed drainage	Tracheotomy	Abdominocentesis	Extraction of chest tube etc.
Others	Turn etc.

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.

Table 3 The management of pain caused by the natural cavity noninvasive catheterization

Operational type	Ref.	Drugs	Advantages	Disadvantages
Fiberbronchoscopy	Chalumeau-Lemoine et al[26], 2013	Remifentanil	Shorten the operational time, reduce discomfort, and have better antitussive effect	May cause respiratory arrest
	Gupta et al[28], 2014	2% lignocaine and viscous lignocaine gargles	Effectively relieve pain and provide comfort	Not mentioned
	Kundra et al[27], 2000	Translaryngeal block, bilateral superior laryngeal nerve block and three 4% lignocaine-soaked cotton swabs in the nose (CRB group)	Provided better patient comfort and haemodynamic stability	Not mentioned
Nasogastric tube intubation	Cullen et al[33], 2004	Nebulized lidocaine	Can significantly alleviate pain	Can cause complications such as nosebleeds
	Ducharme and Matheson[32], 2003	2% lidocaine gel	Effectively alleviate pain and is easy to use	Not mentioned
	Wolfe et al[31], 2000	4% Nebulized lidocaine	Significantly alleviate pain	Not mentioned
	Singer and Konia[30], 1999	Lidocaine, tetracaine	Alleviate pain	Adverse events such as vomiting and nosebleeds
Urethral catheterization	Chung et al[35], 2007	Lidocaine gel	Alleviate pain	Not mentioned
	Siderias et al[34], 2004	Lidocaine gel	Alleviate pain	Not mentioned

CRB: Combined regional block.

Table 4 The management of pain caused by the natural cavity percutaneous catheterization and extubation

Operational type	Ref.	Drugs/physical method	Advantages	Disadvantages
Tracheotomy	Chang[39], 2017	Remifentanil and lidocaine combined with propofol	Can result in a shorter recovery time and more pain tolerable after recovery	Inhibition of heart and breathing
	Dong et al[38], 2011	Monitored anesthesia care	Give patients a higher level of comfort, no memory for tracheotomy and the hemodynamics is more stable	Intravenous administration to patients with difficulty in ventilation or intubation should be cautious
Extraction of chest tube	Puntillo and Ley[40], 2004	Morphine and ketorolac	Alleviate pain	Morphine may cause sedation
	Singh and Gopinath[42], 2005	Valdecoxib	Can alleviate pain safely and effectively	Can't completely alleviate pain
	Gorji et al[43], 2014	Ice packs	Effectively alleviate pain	Not mentioned

Table 5 The management of pain caused by other operations

Operational type	Ref.	Drugs/physical method	Advantages	Disadvantages
Turn	Robleda et al[46], 2016	Fentanyl	Effectively alleviate pain	Non-tracheal intubation patients use caution and may cause respiratory depression or apnea
	de Jong et al[47], 2013	Analgesic drug combined music	Effectively alleviate pain	The feasibility and impact of large-scale routine implementation has not been evaluated