Postoperative Analgesia in Elderly Patients

Authors: Elisabeth Falzone Clément Hoffmann Hawa Keita

Publish Date: 2013/01/04

Volume: 30, Issue: 2, Pages: 81-90

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Abstract

Elderly people represent the fastestgrowing segment of our society and undergo surgery more frequently than other age groups Effective postoperative analgesia is essential in these patients because inadequate pain control after surgery is associated with adverse outcomes in elderly patients However management of postoperative pain in older patients may be complicated by a number of factors including a higher risk of age and diseaserelated changes in physiology and disease–drug and drug–drug interactions Physiological changes related to aging need to be carefully considered because aging is individualized and progressive Assessment of pain management needs to include chronological age biological age with regard to renal liver and cardiac functions and the individual profile of pathology and prescribed medications In addition ways in which pain should be assessed particularly in patients with cognitive impairment must be considered Cognitively intact older patients can use most commonly used unidimensional pain scales such as the visual analogue scale VAS verbal rating scale VRS numeric rating scale NRS and facial pain scale FPS VRS and NRS are the most appropriate pain scales for the elderly In older patients with mild to moderate cognitive impairment the VRS is a better tool For severe cognitively impaired older patients behavioural scales validated in the postoperative context such as Doloplus2 or Algoplus are appropriate For postoperative pain treatment most drugs eg paracetamol nonsteroidal antiinflammatory drugs nefopam tramadol codeine morphine local anaesthetics techniques eg intravenous morphine titration subcutaneous morphine intravenous or epidural patientcontrolled analgesia intrathecal morphine peripheral nerve block and strategies eg anticipated intraoperative analgesia or multimodal analgesia used for acute pain management can be used in older patients However in view of pharmacokinetic and pharmacodynamic changes in older persons the higher incidence of comorbidities and concurrent use of other drugs each must be carefully adjusted to suit each patient Evaluation of treatment efficacy and incidence and severity of adverse events should be monitored closely and the concept of ‘start low and go slow’ should be adopted for most analgesic strategies

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