Key messages

• Analgesia and sedation are primarily independent goals of intensive care therapy.

• Inadequate analgesia may result in increased morbidity.

• Parenteral opioids are the mainstay of effective pain therapy.

• The different pharmacological properties of the opioids have to be considered during long-term administration.

• Ketamine offers advantages in hemodynamically unstable patients and in those with opioid-induced constipation.

• The synergistic action of clonidine with most central analgesics and sedatives is increasingly used to facilitate analgesia and sedation and to prevent the development of tolerance.

• Although central neuraxial blocks provide powerful analgesia, the possible benefits in ventilated patients have to be carefully weighed against the possible risks.

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