Could a cocktail of Non-Opioid drugs replace Morphine-Like painkillers in the ICU?

This trial investigates whether a combination of non-opioid pain medications (paracetamol, nefopam, tramadol, and ketamine) can effectively manage pain in intensive care unit patients who need a breathing machine, while reducing the use of the opioid remifentanil. The study involves 50 adults in the ICU who have been on a ventilator for 2 to 24 hours. Half receive the standard opioid-based pain regimen, and the other half receive the opioid-free mix, with neither patients nor doctors knowing which group they are in. The main goal is to see if the opioid-free approach cuts remifentanil use by at least 15% in the first 48 hours.