Acute Pain Management in the Intensive Care Unit.

PURPOSE OF REVIEW: This review summarizes current approaches to pain assessment and pharmacologic therapy in the intensive care unit (ICU) and evaluates the expanding role of regional anesthesia (RA).

RECENT FINDINGS: Contemporary ICU analgesia emphasizes systematic pain assessment and multimodal therapy while avoiding unnecessary deep sedation. RA provides targeted, opioid-sparing analgesia for localized pain but is limited by coagulopathy, infection, altered anatomy, and practical considerations. Fascial-plane blocks may provide useful alternatives in selected patients. Thoracic epidural and paravertebral techniques remain options for selected patients but may cause hypotension and clinically significant bleeding. Ultrasound-guided techniques, including erector spinae, serratus anterior, parasternal, rectus sheath, and transversus abdominis plane blocks, expand analgesic options. Continuous catheter techniques may extend analgesia when prolonged pain is anticipated. However, evidence in heterogeneous ICU populations remains limited, and much of the current evidence is derived from perioperative or trauma populations rather than general medical ICU cohorts. Further ICU-specific comparative trials are needed to define patient selection and clinically meaningful outcomes.