IV Pain Medication for Shock and Gastritis
In patients with shock and gastritis, low-dose ketamine (0.1-0.3 mg/kg IV) is the preferred IV pain medication due to its hemodynamic stability profile and minimal effects on gastric mucosa. 1
First-Line Pain Management
- Ketamine at low doses (0.1-0.3 mg/kg IV) is recommended as it maintains hemodynamic stability in shock while providing effective analgesia 1
- Ketamine should be administered as a slow IV push and diluted appropriately when using the higher concentration formulation (100 mg/mL) 1
- Unlike opioids, ketamine does not cause significant respiratory depression, making it safer in hemodynamically unstable patients 1
Opioid Considerations
- If ketamine is unavailable or contraindicated, opioids may be used with extreme caution and careful titration 2
- Dilaudid (hydromorphone) is preferred over morphine or fentanyl in non-intubated patients with gastritis due to less histamine release 2
- Opioids should be titrated in small doses to minimize hemodynamic effects in shock patients 2
Multimodal Approach
- For patients with severe pain, consider adding epidural analgesia as an adjunct to IV analgesia once hemodynamic stability is achieved 2
- Patient-controlled analgesia (PCA) should be integrated with the pain management strategy when the patient stabilizes 2
- Dexmedetomidine in combination with low-dose fentanyl may be considered for stable patients as it provides effective analgesia with minimal respiratory depression 3
Gastritis-Specific Considerations
- Avoid NSAIDs completely as they may worsen gastric mucosal injury and are contraindicated in patients with acute kidney injury, which is common in shock 2
- Implement stress ulcer prophylaxis with either proton pump inhibitors or histamine-2 receptor antagonists to prevent worsening of gastritis 2
- Consider early enteral feeding rather than complete fasting to maintain gut mucosal barrier function once the patient is stabilized 2
Monitoring and Precautions
- Continuous vital sign monitoring in a high dependency or intensive care unit is essential for patients with shock and organ dysfunction 2
- Monitor for adverse effects of ketamine including emergence reactions, which can be mitigated with small doses of benzodiazepines if needed 1
- Reassess pain control and hemodynamic status frequently to guide ongoing analgesic management 2
Special Considerations
- In cases of hemorrhagic gastritis, prioritize hemodynamic stabilization before aggressive pain management 4
- For patients with phlegmonous gastritis (severe infectious gastritis), ensure appropriate antibiotic coverage is initiated alongside pain management 5, 6
- In patients requiring mechanical ventilation, higher doses of analgesics may be used with appropriate hemodynamic monitoring 2
Remember that treating the underlying cause of shock and gastritis is paramount while providing adequate pain control to improve patient comfort and outcomes.