PRACTICAL GUIDELINES ON THE POSTOPERATIVE USE OF PATIENT-CONTROLLED ANALGESIA IN THE ELDERLY

Inadequate pain control after surgery is associated with adverse outco mes in elderly patients; for this reason, effective analgesia is an es sential component of postoperative care in this patient group. However , postoperative pain management is challenging in the elderly because of concomitant disease states and physiological factors that can affec t the pharmacodynamic and pharmacokinetic properties of analgesic drug s. Patient-controlled analgesia (PCA) offers advantages over tradition al intramuscular analgesia in this setting, because it provides the op portunity to tailor therapy to the individual, as opposed to the avera ge, patient. Morphine is the most widely used, and presently the most suitable, drug for use in PCA in the elderly. Studies have indicated t hat, after acute pain has been brought under control, PCA should be in itiated at a dose of 1 or 1.5 mg per dose, with a lockout period of 5 to 7 min. Continuous background infusions of opioids are contraindicat ed. Education of patients and healthcare professionals alike is necess ary to optimise the utility of PCA in older patients. In addition, eve ry effort should be made to avoid the development of postoperative con fusion, as this is associated with an increased risk of inefficient pa in relief and its deleterious consequences. In summary, close monitori ng and evaluation of the patient throughout the perioperative period i s required to ensure the appropriate and successful use of PCA in elde rly patients.