Pain Control in Aneurysmal Subarachnoid Hemorrhage Patients in the ICU: Can We Avoid Contributing to the Opioid Crisis?

Critically ill patients with aneurysmal subarachnoid hemorrhage (aSAH) often require pain management, primarily for control of headache and postoperative craniotomy pain. Patients unable to verbalize their needs pose a particular challenge in such management given the inability to monitor level of pain. Opioids are commonly used, but adverse side effects include nausea, vomiting, ileus, hemodynamic instability, and respiratory depression. Patients with extended intensive care unit (ICU) stay may develop tolerance, resulting in dosage escalation, and an altered mental status that can progress to delirium and confound the neurologic examination. Chronic opioid use after hospitalization, defined as daily or near daily use for at least 90 days after discharge, presents an additional concern.1

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