Safe IV opioid titration in patients with severe acute pain.

摘要

PROVIDING EFFECTIVE PAIN control while minimizing opioid-induced adverse effects in patients with severe acute pain presents special challenges for clinicians who work in PACUs, outpatient surgery settings, emergency departments (EDs), and intensive care units (ICUs) because they must also deal with the additional central nervous system depression caused by the sedative and anesthetic agents that are administered intraoperatively, and sometimes throughout care. Rapid analgesia must be provided to patients who are in a nonsteady state, and that adds to the complexity of titration.1 (Steady state is achieved when the rate of excretion of a drug equals the rate at 'which the drug enters the system.) Furthermore, many of these patients are opioid-naive, which places them at greater risk for adverse opioid-induced effects, particularly excessive sedation and respiratory depression.