Best Practice & Research Clinical Anaesthesiology
Volume 21, Issue 1 , Pages 109-127 , March 2007

The elderly patient and postoperative pain treatment

  • Frédéric Aubrun, MD, PhD (Staff anesthesiologist, Department of Anesthesiology and Critical Care)

      Affiliations

    • Corresponding Author InformationCorresponding author. Département d'Anesthésie-Réanimation, CHU Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75651 Paris, Cedex 13, France. Tel.: +33 1 42 16 22 59; Fax: +33 1 42 16 22 69.
  • Frédéric Marmion, MD (Staff anesthesiologist, Department of Anesthesiology and Critical Care)

References 

  1. Rooke GA, Reves JG, Rosow C. Anesthesiology and geriatric medicine: mutual needs and opportunities. Editorial. Anesthesiology. 2002;96:2–4
  2. Clergue F, Auroy Y, Péquignot F, et al. French survey of anaesthesia in 1996. Anesthesiology. 1999;91:1509–1520
  3. Klopfenstein CE, Herrmann FR, Michel JP, et al. The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesthesia and Analgesia. 1998;86:1165–1170
  4. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American geriatrics society/national institute on aging research conference on frailty in older adults. Journal of the American Geriatrics Society. 2006;54:991–1001
  5. Bothner U, Georgieff M, Schwilk B. The impact of minor perioperative anesthesia-related incidents, events, and complications on postanaesthesia care unit utilization. Anesthesia and Analgesia. 1999;89:506–513
  6. Egbert AM, Parks LH, Short LM, Burnett ML. Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men. Archives of Internal Medicine. 1990;150:1897–1903
  7. Cook DJ, Rooke GA. Priorities in perioperative geriatrics. Anesthesia and Analgesia. 2003;96:1823–1836
  8. Feely J, Coakley D. Altered pharmacodynamics in the elderly. Clinics in Geriatric Medicine. 1990;6:269–283
  9. Guay DRP, Artz MB, Hanlon JT, Schmader K. The pharmacology of aging. In:  Raymond C Tallis,  Howard M Fillit editor. Brocklehurst's textbook of geriatric medicine and gerontology. 6th ed.. London: Churchill Livingstone, Elsevier Science; 2003;p. 155–161
  10. Eddington ND. Pharmacokinetics. In:  Roberts Jay,  Snyder David L,  Friedmen Eitan editor. Handbook of pharmacology of aging. 2nd ed.. Boca Raton: CRC; 1996;p. 1–22
  11. Muravchick S. Anesthesia for the elderly. In:  Miller RD editors. Anesthesia. 4th ed.. New York: Churchill Livingstone; 1994;p. 2143–2156
  12. Lund-Johansen P. The hemodynamics of the aging cardiovascular system. Journal of Cardiovascular Pharmacology. 1988;12(supplement 8):S20–S32
  13. Upton RN, Huang YF. Influence of cardiac output, injection time and injection volume on the initial mixing of drugs with venous blood after IV bolus administration to sheep. British Journal of Anaesthesia. 1993;70:333–338
  14. Macintyre PE, Upton RN, Ludbrook GL. Acute pain management in the elderly patient. In:  Rowbotham D,  Macintyre PE editor. Clinical pain management. Acute pain. London: Arnold; 2003;p. 463–483
  15. Aronow WS. Effects of aging on the heart. Cardiovascular disease. In:  Tallis Raymond C,  Fillit Howard M editor. Brocklehurst's textbook of geriatric medicine and gerontology. 6th ed.. London: Churchill Livingstone, Elsevier Science; 2003;p. 341–348
  16. Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. The Clinical Journal of Pain. 2004;20:227–239
  17. Amenta F, Zaccheo D, Collier WL. Neurotransmitters, neuroreceptors and aging. Mechanisms of Ageing and Development. 1991;61:249–273
  18. Harkins SW, Davis MD, Bush FM, Kasberger J. Suppression of first pain and slow temporal summation of second pain in relation to age. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 1996;51A:M260–M265
  19. Gagliese L, Katz J, Melzack R. Pain in the elderly. In:  Wall PD,  Melzack R editor. Textbook of pain. 4th ed.. London: Churchill Livingstone; 1999;p. 991–1006
  20. Gagliese L, Katz J. Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain. 2003;103:11–20
  21. Helme RD, Meliala A, Gibson SJ. Methodological factors which contribute to variations in experimental pain threshold reported for older people. Neuroscience Letters. 2004;361:144–146
  22. Vaurio LE, Sands LP, Wang Y, et al. Postoperative delirium: the importance of pain and pain management. Anesthesia and Analgesia. 2006;102:1267–1273
  23. Lynch E, Lazor M, Gellis JE, et al. The impact of postoperative pain on the development of postoperative delirium. Anesthesia and Analgesia. 1998;86:781–785
  24. Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. The Journal of the American Medical Association. 1994;272:1518–1522
  25. Fong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesthesia and Analgesia. 2006;102:1255–1266
  26. Craig DB. Postoperative recovery of pulmonary function. Anesthesia and Analgesia. 1981;60:46–52
  27. Connoly MJ. Age-related changes in the respiratory system. In:  Tallis Raymond C,  Fillit Howard M editor. Brocklehurst's textbook of geriatric medicine and gerontology. 6th ed.. London: Churchill Livingstone, Elsevier Science; 2003;p. 489–493
  28. Epstein M. Aging and the kidney. Journal of the American Society of Nephrology. 1996;7:1106–1122
  29. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function. Measured and estimated glomerular filtration rate. The New England Journal of Medicine. 2006;354:2473–2483
  30. Brady HR, Brenner BM, Clarkson MR, Lieberthal W. Acute renal failure. In:  Brenner BM editors. The Kidney. 6th ed.. Brenner and Rector's; 2000;p. 1201–1262
  31. Cullen DJ, Hawkey GM, Greenwood DC, et al. Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylorii and non-steroidal anti-inflammatory drugs. Guts. 1997;41:459–462
  32. James OFW. The liver. In:  Tallis RC,  Fillit HM editor. Brocklehurst's textbook of Geriatric Medicine and Gerontology. 6th ed.. London: Churchill Livingstone; 2003;p. 1001–1018
  33. Oberle K, Paul P, Wry J, Grace M. Pain, anxiety and analgesics: a comparative study of elderly and younger surgical patients. Canadian Journal on Aging. 1990;9:13–22
  34. Duggleby W, Lander J. Cognitive status and postoperative pain: older adults. Journal of Pain and Symptom Management. 1994;9:19–27
  35. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27:117–126
  36. Gagliese L, Weizblit N, Ellis W, Chan VW. The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain. 2005;117:412–420
  37. Aubrun F, Paqueron X, Langeron O, et al. What pain scales do nurses use in the postanaesthesia care unit?. European Journal of Anaesthesiology. 2003;20:745–749
  38. Chibnall JT, Tait RC. Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain. 2001;92:173–186
  39. Taylor LJ, Herr K. Evaluation of the faces pain scale with minority older adults. Journal of Gerontological Nursing. 2002;28:15–23
  40. Herr KA, Spratt K, Mobily PR, Richardson G. Pain intensity assessment in older adults. Use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. The Clinical Journal of Pain. 2004;20:207–219
  41. Wary B, Serbouti S, et le collectif Doloplus C. DOLOPLUS-2. Validation d'une échelle comportementale de la douleur chez la personne âgée. Douleurs. 2001;2:35–38
  42. Zwakhalen SM, Hamers JP, Abu-Saad HH, Berger MP. Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatrics. 2006;6:3
  43. Katz B, Helme RD. Pain in old age. In:  Tallis Raymond C,  Fillit Howard M editor. Brocklehurst's textbook of geriatric medicine and gerontology. 6th ed.. London: Churchill Livingstone, Elsevier Science; 2003;p. 1391–1406
  44. Potter JF. The older orthopaedic patient: general considerations. Clinical Orthopaedics and Related Research. 2004;425:44–49
  45. Rakel B, Herr K. Assessment and treatment of postoperative pain in older adults. Journal of Perianesthesia Nursing. 2004;19:194–208
  46. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921–1928
  47. Owen JA, Sitar DS, Berger L, et al. Age-related morphine kinetics. Clinical Pharmacology and Therapeutics. 1983;34:364–368
  48. Kaiko RF. Age and morphine analgesia in cancer patients with postoperative pain. Clinical Pharmacology and Therapeutics. 1980;28:823–826
  49. Kaiko RF, Wallenstein SL, Rogers AG, et al. Narcotics in the elderly. Medicine Clinics of North America. 1982;66:1079–1089
  50. Daykin AP, Bowen DJ, Saunders DA, Norman J. Respiratory depression after morphine in the elderly. A comparison with younger subjects. Anaesthesia. 1986;41:910–914
  51. Moller JT, Wittrup M, Johansen SH. Hypoxemia in the postanaesthesia care unit: an observer study. Anesthesiology. 1990;73:890–895
  52. Sharma PT, Sieber FE, Zakriya KJ, et al. Recovery room delirium predicts postoperative delirium after hip-fracture repair. Anesthesia and Analgesia. 2005;101:1215–1220
  53. Aubrun F, Monsel S, Langeron O, et al. Postoperative titration of intravenous morphine. European Journal of Anaesthesiology. 2001;18:159–165
  54. Upton RN, Semple TJ, Macintyre PE. Pharmacokinetic optimisation of opioid treatment in acute pain therapy. Clinical Pharmacokinetics. 1997;33:225–244
  55. Aubrun F, Monsel S, Langeron O, et al. Postoperative titration of intravenous morphine in the elderly patient. Anesthesiology. 2002;96:17–23
  56. Aubrun F, Bunge D, Langeron O, et al. Postoperative morphine consumption in the elderly patients. Anesthesiology. 2003;99:160–165
  57. Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1996;64:357–364
  58. Mann C, Pouzeratte Y, Eledjam JJ. Postoperative patient-controlled analgesia in the elderly: risks and benefits of epidural versus intravenous administration. Drugs & Aging. 2003;20:337–345
  59. Gagliese L, Jackson M, Ritvo P, et al. Age is not an impediment to effective use of patient-controlled analgesia by surgical patients. Anesthesiology. 2000;93:601–610
  60. Burns JW, Hodsman NB, McLintock TT, et al. The influence of patient characteristics on the requirements for postoperative analgesia. A reassessment using patient-controlled analgesia. Anaesthesia. 1989;44:2–6
  61. Egbert AM, Lampros LL, Parks LL. Effects of patient-controlled analgesia on anxiety in elderly men. American Journal of Critical Care. 1993;2:118–124
  62. Lavand'Homme P, De Kock M. Practical guidelines on the postoperative use of patient-controlled analgesia in the elderly. Drugs & Aging. 1998;13:9–16
  63. Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs. 2000;60:139–176
  64. Coetzee JF, Van Loggerenberg H. Tramadol or morphine administered during operation: a study of immediate postoperative affects after abdominal hysterectomy. British Journal of Anaesthesia. 1998;81:737–741
  65. Miners JO, Penhall R, Robson RA, Birkett DJ. Comparison of paracetamol metabolism in young adult and elderly males. European Journal of Clinical Pharmacology. 1988;35:157–160
  66. Divoll M, Abernethy DR, Ameer B, Greenblatt DJ. Acetaminophen kinetics in the elderly. Clinical Pharmacology and Therapeutics. 1982;31:151–156
  67. Kostamovaara PA, Hendolin H, Kokki H, Nuutinen LS. Ketorolac, diclofenac and ketoprofen are equally efficacious for pain relief after total hip replacement surgery. British Journal of Anaesthesia. 1998;81:369–372
  68. Alexander R, El-Moalem HE, Gan TJ. Comparison of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopaedic surgery. Journal of Clinical Anesthesia. 2002;14:187–192
  69. Peura DA. Prevention of nonsteroidal anti-inflammatory drug-associated gastrointestinal symptoms and ulcer complications. The American Journal of Medicine. 2004;117(supplement 5A):63S–71S
  70. Forrest JB, Camu F, Greer IA, et al. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. British Journal of Anaesthesia. 2002;88:227–233
  71. Johnson AG, Day RO. The problems and pitfalls of NSAID therapy in the elderly. Part II. Drugs & Aging. 1991;1:130–143
  72. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. The New England Journal of Medicine. 1999;340:1888–1899
  73. Brouwers JR, de Smet PA. Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs. Clinical Pharmacokinetics. 1994;27:462–485
  74. Buvanendran A, Kroin JS, Tuman KJ, et al. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement. A randomized controlled trial. The Journal of the American Medical Association. 2003;290:2411–2418
  75. Bell GM, Schnitzer TJ. COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs in the treatment of pain in the elderly. Clinics in Geriatric Medicine. 2001;17:489–502
  76. Gilron I, Milne B, Hong M. Cyclooxygenase-2 Inhibitors in postoperative pain management. Anesthesiology. 2003;99:1198–1208
  77. Reinhold SW, Fischereder M, Riegger GA, Kramer BK. Acute renal failure after administration of a single dose of a highly selective COX-2 inhibitor. Clinical Nephrology. 2003;60:295–296
  78. Solomon SD, McMurray JJ, Pfeffer MA, et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. The New England Journal of Medicine. 2005;352:1071–1080
  79. Nussmeier NA, Whelton AA, Brown MT, et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. The New England Journal of Medicine. 2005;352:1081–1091
  80. Winkler JD. Non steroidal anti-inflammatory drugs. In:  Roberts Jay,  Snyder David L,  Friedmen Eitan editor. Handbook of pharmacology of aging. 2nd ed.. Boca Raton: CRC; 1996;p. 341–353
  81. Sharrock NE. Epidural anesthetic dose responses in patients 20 to 80 years old. Anesthesiology. 1978;49:425–428
  82. Ferrer-Brechner T. Spinal and epidural anesthesia in the elderly. Seminars in Anesthesia. 1986;5:54–61
  83. Liu SS, Carpenter RL, Mackey DC, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology. 1995;83:757–765
  84. Capdevila X, Barthelet Y, Bibloulet P, et al. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15
  85. Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology. 2000;92:433–441
  86. Rathmell JP, Pino CA, Taylor R, et al. Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesthesia and Analgesia. 2003;97:1452–1457
  87. Sakai T, Use T, Shimamoto H, et al. Mini-dose (0.05mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate. Canadian Journal of Anaesthesia. 2003;50:1027–1030
  88. Brown DR, Hofer RE, Patterson DE, et al. Intrathecal anesthesia and recovery from radical prostatectomy: a prospective, randomized, controlled trial. Anesthesiology. 2004;100(4):926–934
  89. Juelsgaard P, Sand NP, Felsby S, et al. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. European Journal of Anaesthesiology. 1998;15:656–663
  90. Murphy PM, Stack D, Kinirons B, et al. Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty. Anesthesia and Analgesia. 2003;97:1709–1715
  91. Klein SM, Nielsen KC, Greengrass RA, et al. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesthesia and Analgesia. 2002;94:65–70
  92. Atanassoff PG. Effects of regional anesthesia on perioperative outcome. Journal of Clinical Anesthesia. 1996;8:446–455
  93. Mulroy MF, Mc Donald SB. Regional anesthesia for outpatient surgery. Anesthesiology Clinics of North America. 2003;21:289–303
  94. Paqueron X, Boccara G, Bendahou M, et al. Brachial plexus nerve block exhibits prolonged duration in the elderly. Anesthesiology. 2002;97:1245–1249
  95. Veering BT, Burm AG, Van Kleef JW, et al. Epidural anaesthesia with bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesthesia and Analgesia. 1987;66:589–593
  96. Zaric D, Boysen K, Christiansen C, et al. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesthesia and Analgesia. 2006;102:1240–1246
  97. Singelyn FJ, Ferrant T, Malisse MF, Joris D. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Regional Anesthesia and Pain Medicine. 2005;30:452–457

PII: S1521-6896(06)00086-3

doi: 10.1016/j.bpa.2006.12.005

Best Practice & Research Clinical Anaesthesiology
Volume 21, Issue 1 , Pages 109-127 , March 2007

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