Yoğun Bakım Ünitesinde Analjeziye Güncel Bakış
Synopsis
In intensive care units, pain is one of the most common and significant stressors experienced by patients, originating from physical causes such as trauma, surgery, invasive procedures, routine care, noise, and immobility, as well as emotional factors including fear, anxiety, and sleep disorders. The body exhibits physiological responses to pain through psychological, emotional, and sympathetic or parasympathetic nervous systems. Inadequately managed pain can lead to elevated catecholamine levels, reduced tissue blood flow, hyperglycemia, catabolic breakdown, immunosuppression, ventilator dyssynchrony, atelectasis, pneumonia, and psychological disturbances. Although self-reporting by the patient is considered the gold standard in pain assessment, evidence-based tools such as the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are utilized for uncommunicative critical patients. While opioid analgesics like morphine, fentanyl, remifentanil, and methadone are widely used for pain control, they carry serious side effect risks such as tolerance, respiratory depression, and hypotension. To decrease opioid consumption and adverse effects, non-opioid agents including paracetamol, NSAIDs (ketorolac), ketamine, and dexmedetomidine are preferred within multimodal analgesia regimens. Additionally, non-pharmacological methods such as music therapy, hot/cold application, massage, and TENS are increasingly applied to support pain management.
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