Regional analgesia in the intensive care unit. Principles and practice

Nociception is a complicated process, and only in recent years have the neural pathways and mediators of pain transmission been unraveled. Several regional anesthetic interventions, most notably epidural drug delivery, can interrupt nociception and provide safe and effective pain control in critically ill patients while substantially reducing the need for systemic medications. This article discusses the possibilities for regional control of the neurobiology of nociception and describes the arsenal of regional anesthetic techniques available to the intensivist. Used wisely, regional techniques can provide excellent pain control and may have a significant role in improving overall patient outcome. Regional analgesia offers the best opportunity to provide substantial analgesia without significant central opioid effects. Well-conducted regional analgesia can reduce many of the unpleasant or potentially problematic side effects observed when traditional intravenous medications are used exclusively for pain control.