Regional anesthesia and POCUS in the intensive care unit

Abstract

The management of pain in the critical care setting can be challenging and complex due to patient comorbidities and the reduced capacity of critically ill patients to communicate their pain severity. A majority of patients in the intensive care unit (ICU) report moderate to severe pain, inadequate pain control, and negative memories of their ICU stay secondary to pain. 1 – 3 However, untreated pain can not only be a very stressful and unpleasant experience for the patient, but it may also result in deleterious physiological effects, increased morbidity and mortality, and increased hospital costs. Regional anesthesia (RA) and multimodal analgesia are key components for successful pain management in the ICU, as opioids may worsen the cardiac and pulmonary status of the already critically ill patient. In addition, point-of-care ultrasound (POCUS) is a valuable and inexpensive diagnostic tool that can be used at the bedside or during critical situations in the ICU to quickly diagnose and treat acute changes in a patient ’ s status. The utility of ultrasound and RA has grown and continues to grow exponentially over the last decade.