Vol. 7, Issue 1, Part A (2025)

Background: Critically ill patients in the ICU frequently undergo short yet painful procedures such as suctioning and wound dressing, which can trigger harmful physiological stress responses. Remifentanil, a potent, ultra-short-acting opioid, is typically used intravenously but may cause complications due to line access. The intranasal (IN) route offers a promising, non-invasive alternative due to its rapid onset and ease of administration. Aim: This study aims to evaluate the efficacy and safety of intranasal remifentanil in managing procedural pain in intubated, mechanically ventilated ICU patients. Method: A cross-sectional clinical trial was conducted in the adult ICU of Imam Hussain Medical City, Karbala, in 2023. Fifty adult, intubated but non-sedated patients received a 200 µg dose of IN remifentanil before routine procedures. Pain levels were measured using the Critical-Care Pain Observation Tool (CPOT), and hemodynamic parameters (heart rate and mean arterial pressure) were recorded before and three minutes after administration.

Results: The mean CPOT score significantly decreased from 4.25 to 1.20 (p<0.001), indicating effective pain relief. Heart rate dropped from 102.90 to 89.30 bpm (p = 0.0418), suggesting reduced stress, while MAP decreased from 96.80 to 89.20 mmHg without statistical significance (p = 0.0921). No adverse events were observed.

Conclusion: Intranasal remifentanil provides rapid and effective analgesia during painful ICU procedures in intubated patients, with favorable safety and hemodynamic profiles. This non-invasive approach can be a valuable alternative in critical care analgesia protocols.