Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study

Benjamin L Moran; David A Scott; Elizabeth Holliday; Serena Knowles; Manoj Saxena; Ian Seppelt; Naomi Hammond; John A Myburgh; George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Pain in Survivors of Intensive Care Units (PAIN-ICU) Study Investigators

doi:10.51893/2022.3.OA1

Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study

Crit Care Resusc. 2023 Oct 18;24(3):224-232. doi: 10.51893/2022.3.OA1. eCollection 2022 Sep 5.

Authors

Benjamin L Moran^{1

2

3

4}, David A Scott^{5

6}, Elizabeth Holliday^{4

7}, Serena Knowles¹, Manoj Saxena^{1

8}, Ian Seppelt^{1

9

10}, Naomi Hammond^{1

11}, John A Myburgh^{1

12}; George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Pain in Survivors of Intensive Care Units (PAIN-ICU) Study Investigators

Affiliations

¹ Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia.
² Department of Intensive Care, Gosford Hospital, Gosford, NSW, Australia.
³ Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, NSW, Australia.
⁴ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
⁵ Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
⁶ Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
⁷ Clinical Research Design and Statistics Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia.
⁸ Department of Intensive Care Medicine, Bankstown Hospital, Sydney, NSW, Australia.
⁹ Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia.
¹⁰ Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
¹¹ Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
¹² Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia.

Abstract

Objective: To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand. Design, setting and participants: Prospective, observational, multicentre, single-day point prevalence study conducted in Australian and New Zealand ICUs. Observational data were recorded for all adult patients admitted to an ICU without a neurological, neurosurgical or postoperative cardiac diagnosis. Demographic characteristics and data on pain assessment and analgesic management for a 24-hour period were collected. Main outcome measures: Types of pain assessment tools used and frequency of their use, use of opioid analgesia, use of adjuvant analgesia, and differences in pain assessment and analgesic management between postoperative and non-operative patients. Results: From the 499 patients enrolled from 45 ICUs, pain assessment was performed at least every 4 hours in 56% of patients (277/499), most commonly with a numerical rating scale. Overall, 286 patients (57%) received an opioid on the study day. Of the 181 mechanically ventilated patients, 135 (75%) received an intravenous opioid, with the predominant opioid infusion being fentanyl. The median dose of opioid infusion for ventilated patients was 140 mg oral morphine equivalents. Of the 318 non-ventilated patients, 41 (13%) received patient-controlled analgesia and 76 (24%) received an oral opioid, with the predominant opioid being oxycodone. Paracetamol was administered to 63 ventilated patients (35%) and 164 non-ventilated patients (52%), while 2% of all patients (11/499) received a non-steroidal anti-inflammatory drug. Ketamine infusion and regional analgesia were used in 15 patients (3%) and 17 patients (3%), respectively. Antineuropathic agents (predominantly gabapentinoids) were used in 53 patients (11%). Conclusions: Although a majority of ICU patients were frequently assessed for pain with a validated pain assessment tool, cumulative daily doses of opioids were high, and the use of multimodal adjuvant analgesia was low. Our data on current pain assessment and analgesic management practices may inform further research in this area.