Principles of analgesia without a significantly depressed conscious state

Analgesia without a significantly depressed conscious state is indicated when nonpharmacological interventions, local or regional anaesthesia and oral analgesics are inadequate for the procedure (eg if the time to analgesia with oral drugs is too long). Conscious state may be altered (eg sense of euphoria) but awareness of surroundings is not depressed. Unpleasant awareness of the procedure or inadequate analgesia may occur.

Overview of procedural sedation and analgesia levels  lists the interventions commonly used to achieve analgesia without a significantly depressed conscious state. Factors influencing the choice of drug used for procedural sedation and analgesia  lists factors influencing drug choice, and Commonly used drugs for procedural sedation and analgesia  outlines the properties of commonly used drugs for procedural sedation and analgesia.

An inhaled analgesic can be used alone for analgesia without a significantly depressed conscious state. If an opioid is used for a short procedure, a single dose is often adequate. A repeat dose may be given if necessary, but more than two doses should be avoided because of the risk of inadvertently proceeding to conscious sedation. An opioid can be added to an inhaled analgesic for additional analgesia. If combination therapy is used, the opioid is given first and treatment with the inhaled analgesic is not started until the full effect of the opioid is achieved. The inhaled analgesic is then administered, as required, throughout the procedure. See Drug regimens for analgesia without a significantly depressed conscious state.

It is easy to inadvertently proceed from analgesia without a significantly depressed conscious state to conscious sedation. Staff involved in delivering or monitoring analgesia without a significantly depressed conscious state must be able to assess the level of sedation achieved, manage conscious sedation if it were to occur, and have resuscitation skills relevant to the patient’s age and condition; see Requirements for procedural sedation and analgesia. To reduce the risk of achieving deeper sedation than intended (ie conscious sedation), drugs must be cautiously titrated to effect.

If analgesia without a significantly depressed conscious state proves to be inadequate to perform the procedure, conscious sedation may be required. However, it must only be used if the requirements for monitoring, staffing, and equipment and physical facilities for conscious sedation are met.