What are the steps for inducing analgesia in patients?

From the Guidelines

To induce analgesia in patients, a multimodal approach should be used, combining non-opioid medications, opioids, and non-pharmacological interventions, as this approach has been shown to decrease opioid exposure and improve pain control, as seen in the 2024 study by the World Journal of Emergency Surgery 1.

Steps for Inducing Analgesia

The following steps should be taken to induce analgesia in patients:

• Assess the patient's pain level, medical history, and any allergies to determine the appropriate analgesic
• Use non-opioid medications like acetaminophen (500-1000mg every 6 hours, maximum 4g daily) or NSAIDs such as ibuprofen (400-800mg every 6-8 hours, maximum 3200mg daily) for mild to moderate pain
• For more severe pain, opioids like morphine (2.5-10mg IV every 4 hours as needed) or hydrocodone (5-10mg orally every 4-6 hours) may be necessary, with the initial infusion of opioids using intravenous patient-controlled analgesia avoided in opioid naïve patients, as recommended by the 2022 study by the World Journal of Emergency Surgery 2
• Start with the lowest effective dose and titrate up as needed while monitoring for side effects
• Consider using a multimodal analgesic approach, which includes the use of systemic analgesics, regional analgesic techniques, and non-pharmacological interventions, as this approach has been shown to be effective in reducing opioid exposure and improving pain control, as seen in the 2024 study by the World Journal of Emergency Surgery 1 ### Key Considerations
• Regular reassessment of pain levels using standardized scales ensures the effectiveness of the regimen
• Timing is crucial—administer analgesics before pain becomes severe, as prevention is more effective than treatment of established pain
• Document all medications given, their effects, and any adverse reactions
• The goal of analgesia is not just pain reduction but also improved function and quality of life, allowing for better recovery and reduced physiological stress response, which can improve healing outcomes ### Opioid Use
• Opioids should be used with caution, as they are associated with an important side effect and the risk of drug dependency, as noted in the 2022 study by the World Journal of Emergency Surgery 2
• The use of opioids should be individualized, with consideration given to the patient's age, type of pain, and medical history, as recommended by the 2024 study by the World Journal of Emergency Surgery 1
• A 20 to 25% dose reduction per decade after age 55 may reduce opioid exposure without altering pain control, as seen in the 2024 study by the World Journal of Emergency Surgery 1

From the Research

Steps for Inducing Analgesia in Patients

The steps for inducing analgesia in patients can be summarized as follows:

• Pre-medication with agents such as sodium diclofenac, midazolam, fentanyl, or ketamine 3, 4, 5
• Induction of anesthesia using a combination of agents such as propofol, ketamine, and nitrous oxide 3, 4
• Maintenance of anesthesia using a combination of agents such as propofol, ketamine, and nitrous oxide 3, 4
• Monitoring of hemodynamic changes, depth of anesthesia, and post-operative pain 3, 4

Agents Used for Sedation and Analgesia

The following agents are commonly used for sedation and analgesia:

• Midazolam and propofol for sedation 6, 7
• Fentanyl, sufentanil, and morphine for analgesia 6, 7
• Ketamine for sedation and analgesia 3, 4, 5
• Remifentanil for analgesia-based sedation 7

Comparison of Different Agents and Techniques

Studies have compared the effectiveness of different agents and techniques for inducing analgesia, including:

• Comparison of sodium diclofenac, ketamine, and propofol with fentanyl and midazolam 3
• Comparison of low-dose fentanyl, propofol, midazolam, ketamine, and lidocaine combination with regular dose propofol and fentanyl combination 4
• Comparison of propofol and fentanyl with midazolam and fentanyl for sedation and analgesia in ICU patients 6
• Comparison of ketamine/propofol with midazolam/fentanyl for procedural sedation and analgesia in the emergency department 5