Provision of comprehensive care in the intensive care unit (ICU) setting should include pain control. Frequently, using parenteral opioid as-needed doses (PRN), or patient-controlled analgesia (PCA) is sufficient. In some cases, however, regional anesthetic techniques can effectively augment the pain control regimen. These techniques may dramatically improve outcome (e.g., continuous plexus block after limb reattachment).

This article discusses intercostal, interpleural, paravertebral, continuous brachial plexus techniques, and intraperitoneal lavage. These techniques are widely applicable in the surgical intensive care unit, usually in the postoperative setting, and with trauma patients, although certain techniques may have limited roles in the medical intensive care unit (e.g., patients with thoracostomy tubes). In cases of trauma, a careful review of the patient's history and communication with the surgical team is necessary to coordinate interventions with those of the trauma surgeon. Although treatment of pain and anxiety is laudable, well-intentioned use of sedative hypnotic agents and analgesics may compromise the ability of the surgeon to evaluate the patient, which is especially important early in their hospital course.<sup>28 Yin W. General Surgery and Trauma Regional Anesthesia and Analgesia Philadelphia: WB Saunders (1996).  502-504

Cliquez ici pour aller à la section Références</sup> In some cases, overzealous attempts at sedating a trauma patient may depress airway reflexes and respiratory drive, cause hypotension, and obfuscate changes in mental status.

In patients who have been deemed candidates for regional analgesia, other factors may argue against its safe implementation (Table 1). The decision to proceed with regional analgesia must be considered in light of the severity of the pain, the applicability of the technique to the painful condition, alternative methods of pain control, the possible side effects of a block, and the risk benefit ratio of the technique itself.