[Analgesia in critical cares]

Pain is a problem in critically ill patients. The diagnosis of the intensity of is more simple when the patient is conscious (using ad hoc scales) than in unconscious or sedated patients. In these cases the study of the physiological responses to pain can be the best way of pain monitoring. The pain management in ICU patients must be a priority of the treatment. Opioids are the pharmacological group more advisable for pain treatment in ICU. Intravenous administration in continuous perfusion is the more accepted route for this treatment. The use of other routes (subcutaneous, intramuscular, oral, intramuscular and transcutaneous) must be restricted due to the potential lack of activity for the fragment variability of biodisponibility of drugs. Complementary to the intravenous administration opioids are the use of bolus or the supplementation with non-opioids analgesics. Morphine, fentanyl, remifentanyl and tramadole are the opioids more used critical ill patients. Ketamine, metamizole and acetaminophen must be considered as non-opioid alternative therapeutic. NSAIDS are non recommended for this group of patients.