Assessment and treatment of postoperative pain in older adults (original) (raw)
Related papers
Postoperative pain management in elderly patients: an integrative review (Atena Editora)
Postoperative pain management in elderly patients: an integrative review (Atena Editora), 2024
Introduction: Postoperative pain has long been recognized as a critical concern in patient recovery. Effective treatment of postoperative pain is critical not only for the immediate well-being of the patient but also to prevent chronicity of pain and its associated complications. Traditionally, opioids have been the mainstay of postoperative analgesia, despite their adverse effects and risk of addiction. 1Methodology: This study adopts the integrative literature review approach, the research selected studies published between 2019 and 2024, using specific descriptors in databases such as MEDLINE, WPRIM and Google Scholar, of the articles found seven were selected and analyzed, where it was demonstrated that multimodal analgesia is effective in the treatment of postoperative pain and contributes to the reduction of the use of opioids. Discussion: Recent studies have demonstrated the effectiveness of multimodal analgesia in procedures. For a more detailed analysis on the topic in question, we categorized the selected articles into 1- Effectiveness of Multimodal Analgesia Techniques, 2- Challenges and Specific Considerations in Elderly Patients, 3- Recent Developments and Innovations in Analgesia Techniques. Conclusion: Multimodal anesthesia in the postoperative period of the elderly offers an effective and safe method for pain control, promoting faster recovery and minimizing the risks associated with excessive use of opioids. The adoption of these strategies in clinical practice can significantly improve surgical outcomes and the quality of life of elderly patients.
An update on pain management for elderly patients undergoing ambulatory surgery
Current Opinion in Anesthesiology, 2016
Purpose of review The aim of this review is to provide an overview of the drugs and techniques used for multimodal postoperative pain management in the older population undergoing surgery in the ambulatory setting. Recent findings Interest has grown in the possibility of adding adjuncts to a single shot nerve block in order to prolong the local anesthetic effect. The rapid and short-acting local anesthetics for spinal anesthesia are potentially beneficial for day-case surgery in the older population because of shorter duration of the motor block, faster recovery, and less transient neurologic symptoms. Another recent advance is the introduction of intravenous acetaminophen, which can rapidly achieve rapid peak plasma concentration (<15 min) following infusion and analgesic effect in 5 min with a duration of action up to 4 h.
A review of the literature on post-operative pain in older cancer patients
European Journal of Cancer, 2007
Post-operative pain in older people is a growing problem as the number of those undergoing surgical procedures for cancer continues to increase. Difficulties arise because of the complex nature of the pain itself and the variable manner in which older people can present and respond to treatment. Inadequately treated acute pain can result in significant consequences. Not all healthcare professionals have sufficient knowledge and training in this specific area. Management is also hindered by the limited kinds of pharmacological and non-pharmacological treatments actually available on a day-today basis. Nonetheless, much can still be done. Instead of being protocol driven, post-operative pain management should be tailored to the individual patient's requirements. This can be achieved through effective communication between healthcare team and patient, careful pre-operative planning and selective use of common analgesics based on knowledge of the different advantages and disadvantages of each.
Age Is Not an Impediment to Effective Use of Patient-controlled Analgesia by Surgical Patients
Anesthesiology, 2000
Obstacles to the use of patient-controlled analgesia (PCA) by elderly surgical patients have not been well-documented. Age differences in preoperative psychological factors, postoperative pain and analgesic consumption, treatment satisfaction, and concerns regarding PCA were measured to identify factors important to effective PCA use. Preoperatively, young (mean age +/- SD, 39 +/- 9 yr; n = 45) and older (mean age +/- SD, 67 +/- 8 yr; n = 44) general surgery patients completed measures of attitudes toward and expectations of postoperative pain and PCA, psychological distress, health opinions, self-efficacy, and optimism. On the first 2 postoperative days, pain at rest and with movement and satisfaction with pain control were assessed using visual analog scales. Daily opioid intake was recorded. When PCA was discontinued, satisfaction and concerns about it were assessed. The older patients expected less intense pain (P </= 0.003) and preferred less information about (P </= 0.02) and involvement in (P </= 0.002) health care than young patients. There were no age differences with regard to pain at rest (P </= 0.22) or with movement (P </= 0.68). The older group self-administered less opioid than the young group (P </= 0.0001) and received PCA for more days than the young group (P </= 0.004). The groups did not differ in concerns about pain relief, adverse drug effects, including opioid addiction, and equipment use or malfunction. Satisfaction with PCA was high and did not differ between the groups. Patient-controlled analgesia use was not hindered by age differences in beliefs about postoperative pain and opioids. Younger and older patients attained comparable levels of analgesia and were equally satisfied with their pain control.
Pattern of postoperative pain management among adult surgical patients in a low-resource setting
Journal of Pain Research, 2012
Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria). Methods: Following ethical approval, a prospective observational study of consecutive adult patients who had surgery at the ABUTH Zaria was performed from January to December 2005. The data were entered into a proforma and analyzed using the Minitab statistical package. Results: One hundred and thirty-eight patients were included in the study. The age range was 17 to 80 years, with a mean age of 41 years. One hundred and thirty-two (95.7%) of the prescriptions were written solely by the surgeon or surgical resident; passive suggestions were given by the anesthetists for only six patients (4.3%). Intermittent intramuscular injections of opioids/ opiates were prescribed for 126 patients (91.3%), while nine patients (6.5%) received intermittent intramuscular injections with non-steroidal anti-inflammatory drugs. Oral paracetamol was prescribed for six patients (4.3%), while three patients (2.1%) received no postoperative analgesic. Moderate pain was recorded in 48 patients (34.8%), and 90 patients (65.2%) had mild pain 8 hours after their operation before subsequent doses of analgesics were given. More females (81 patients [58.7%]), than males (42 patients [29.7%]) suffered moderate to severe pain. The reported side effects were nausea (reported by 32.6% of patients), dry mouth (21.7%), vomiting (13.0%), and urinary retention (6.5%), with 32.6% of patients experiencing no side effects. The three patients who received no analgesics experienced vomiting as a side effect. Despite the high incidence of pain and other side effects, 108 patients (78.2%) still reported that the methods of postoperative pain management were satisfactory. Conclusion: Despite recent advances and the development of more effective techniques for postoperative pain control, a high proportion of patients still experience moderate to severe postoperative pain. Intermittent intramuscular injection of analgesic medication remains the mainstay of postoperative pain management at the ABUTH Zaria. Anesthetists should be more involved in postoperative analgesia prescriptions and should include other forms of multimodal pain management in their regimens. With proper application of current knowledge and training, postoperative pain management can be improved.
Journal of Clinical Nursing, 2014
Aims and objectives. To evaluate the reliability and validity of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators in Chinese older adults post surgery during the anaesthesia recovery period. Background. Pain assessment in older surgical patients is complicated by factors such as anaesthesia and opioid administration. Although observational pain behavioural assessment tools have been validated for those unable to self-report, research on their application during the anaesthesia recovery period is limited. Design. A prospective correlational design. Methods. Ninety-three older patients admitted for scheduled abdominal surgery were recruited in a university-affiliated hospital. The two observational scales were used to conduct pain assessments during the anaesthesia recovery period. On the first and the third postoperative day, participants recalled their pain intensity during the recovery period using the Numeric Rating Scale or the Faces Pain Scale-Revised. Results. The internal consistency reliability of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators was 0Á81 and 0Á69 respectively. The correlation between scores of the two observational scales was 0Á95. The recalled self-reports of pain intensity were significantly correlated. The correlation of the Pain Assessment in Advanced Dementia scale and patients' recalled self-reports was 0Á55, 0Á54, and the correlation between the Checklist of Nonverbal Pain Indicators and the two recalled pain scores was both 0Á60. Conclusions. Both the two observational scales had good reliability and validity when used to assess pain in Chinese surgical older adults during the anaesthesia recovery period. Relevance to clinical practice. Observational pain scales can be useful as a tool for patients unable to self-report. Accurate use of one of the observational pain tools can help identify pain during the anaesthesia recovery period, when patients are unable to self-report, to support effective pain management during this period. What does this paper contribute to the wider global clinical community? • Both the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators had good reliability and validity when used to assess pain in Chinese surgical older adults during the anaesthesia recovery period.
Pain, Anxiety and Analgesics: A Comparative Study of Elderly and Younger Surgical Patients
Canadian Journal on Aging / La Revue canadienne du vieillissement, 1990
RÉSUMÉAfin de déterminer si l'expérience postopératoire diffère entre les patients âgés et les patients plus jeunes, 41 patients âgés (65 ans et plus) et 249 patients plus jeunes (moins de 65 ans) participèrent à cette étude. La douleur et l'anxiété furent mesurées les deuxième et troisième jours postopératoires. L'anxiété fut aussi mesurée avant la chirurgie. Le nombre d'analgésiques presents et donnés, ainsi que le délai entre l'administration du dernier analgésique et l'evaluation de la douleur furent notés. Tandis que l'intensité de la douleur ne variait pas significativement, le nombre d'analgésiques donnés était significativement différent, les personnes âgées en recevant moins. Les patients des deux groupes reçurent moins d'analgésiques le troisième jour postopératoire, indépendamment de l'intensité de la douleur. Les sujets des deux groupes choisirent les descripteurs de douleur de façon presque identique. De fortes associations furent...