Skip to Main Content


Numerical Rating Pain Scale: 0 (no pain) to 10 (most severe pain) scale.

Figure 164-1. Visual Analog Scale (VAS)
Graphic Jump Location

It is a horizontal line with no pain on the left and severe pain on the right. Patients mark along the line to represent their level of pain, which is then measured in mm. A 10 cm long line is recommended.

Figure 164-2. Wong–Baker FACES Pain Rating Scale
Graphic Jump Location

This scale uses six drawings of facial features ranging from smiling (no pain) to crying (severe pain). It has been validated for use in children over 3 years of age. Reprinted with permission from Hockenberry M, Wilson D, Winkelstein ML. Wong's Essentials of Pediatric Nursing, 8th ed. Copyright © 2009, Mosby, St. Louis.


The following are commonly used scales to monitor sedation in patients receiving opioids; monitoring sedation during PCA use is especially critical.

Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Pasero Opioid-Induced Sedation Scale
ScoreLevel of sedation
SSleep, easy to arouse
1Awake and alert
2Slightly drowsy, easily aroused
3Frequently drowsy, arousable
4Somnolent, hard to arouse
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Ramsay Sedation Scale
ScoreLevel of sedation
1Anxious and agitated or restless, or both
2Cooperative, oriented, and tranquil
3Responds to commands only
4Brisk response to light glabellar tap or loud auditory stimulus
5Sluggish response to light glabellar tap or loud auditory stimulus
6No response to a light glabellar tap or loud auditory stimulus
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Richmond Agitation–Sedation Scale
ScoreLevel of agitation or sedationDescription
+4CombativeCombative or violent
+3Very agitatedAttempts to remove tubes or catheters or is aggressive toward staff
+2AgitatedNonpurposeful movement or ventilator dyssynchrony
+1RestlessAnxious but nonaggressive or nonvigorous movements
0Alert and calm
−1DrowsyNot fully alert but with >10 s awakening with eye contact to voice
−2Light sedation<10 s awakening with eye contact to voice
−3Moderate sedationAny movement other than eye contact to voice
−4Deep sedationNot responsive to voice but moves with physical stimulation
−5UnarousableNot responsive to voice or physical stimulation
1. Pasero C, McCaffery M. Safe use of a continuous infusion with IV PCA. J Perianesth Nurs. 2004 Feb;19:42–45.   [PubMed: 14770384]
2. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974 Jun;2:656–659.   [PubMed: 4835444]
3. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002 Nov;166(10):1338–1344.   [PubMed: 12421743]
4. Wong DL, Baker CM. ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.