Perioperative analgesia in the elderly

Saudi Journal of Anaesthesia · 6 authors, 4 centres

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FIDELITY 100%

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AGENT 01 · STRUCTURED SUMMARY

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TL;DR

The central recommendation is that combined multimodal and opioid-sparing analgesia is essential to optimize pain control while minimizing age-related adverse effects in older adults.

Full summary

691 CHARS

Age-related physiological changes, comorbidities, and polypharmacy complicate analgesia in older adults, necessitating individualized preoperative assessment of physical status, cognitive reserve, and chronic pain conditions. Adjuvants including dexamethasone, magnesium sulfate, and ketamine at sub-anesthetic doses are discussed as means to reduce opioid requirements. Target-controlled infusion of remifentanil compared to conventional infusion reduces peri-incisional hyperalgesia. The review concludes that a collaborative interdisciplinary team approach combining multimodal analgesia with non-pharmacological methods is essential for optimizing outcomes in this vulnerable population.

STUDY TYPE

narrative_review

SPECIALTY

surgery

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AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10540995

Perioperative analgesia in the elderly

Saudi Journal of Anaesthesia

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ABSTRACT

ABSTRACT The administration of analgesic drugs in elderly patients should take into account age-related physiological changes, loss of efficiency of homeostatic mechanisms, and pharmacological interactions with chronic therapies. Underestimation of pain in patients with impaired cognition is often linked to difficulties in pain assessment. In the preoperative phase, it is essential to assess the physical status, cognitive reserve, and previous chronic pain conditions to plan effective analgesia. Furthermore, an accurate pharmacological history of the patient must be collected to establish any possible interaction with the whole perioperative analgesic plan. The use of analgesic drugs with different mechanisms of action for pain relief in the intraoperative phase is a crucial step to achieve adequate postoperative pain control in older adults. The combined multimodal and opioid-sparing strategy is strongly recommended to reduce side effects. The use of various adjuvants is also preferable. Moreover, the implementation of non-pharmacological approaches may lead to faster recovery. High-quality postoperative analgesia in older patients can be achieved only with a collaborative interdisciplinary team. The aim of this review is to highlight the perioperative pain management strategies in the elderly with a special focus on intraoperative pharmacological interventions.

CITATION EXPORT

Filippo Del Tedesco, Flaminio Sessa, Rikardo Xhemalaj et al.. Perioperative analgesia in the elderly. Saudi Journal of Anaesthesia. (2023). https://doi.org/10.4103/sja.sja_643_23

AUTHORS

6 · 4 CENTRES

Filippo Del Tedesco, Flaminio Sessa, Rikardo Xhemalaj, Liliana Sollazzi, Cinzia Dello Russo, Paola Aceto

1Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
2Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
3Dipartimento di Sicurezza e Bioetica, Sezione di Farmacologia, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4Department of Pharmacology and Therapeutics, Institute of Systems Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, United Kingdom