THE MANAGEMENT OF POSTSURGICAL PAIN IN THE ELDERLY POPULATION

It is likely that the trend towards ever more aggressive surgery in el derly and possibly frail patients will continue, with the lifting of t raditional age limits, Recent evidence has shown that surgical trauma induces processes of nervous system sensitisation that contributes to and enhances postoperative pain and leads to chronic pain. This knowle dge provides a rational basis for pro-active, pre-operative and post-o perative analgesic strategies which can reduce the neuronal barrage as sociated with tissue damage, As well as a reduction or elimination of post-operative pain, an improvement in physiological variables, such a s neuroendocrine stress responses and post-operative pulmonary functio n can be expected. Complete pain control cannot be achieved with a sin gle agent or technique without significant serious adverse effects, a problem which is compounded in the elderly patient due to a combinatio n of slower drug metabolism, decreased organ function and physiologica l changes in cardiovascular and respiratory reserves. A balanced analg esic regimen that includes an effective afferent block (regional analg esia) is more appropriate. By preventing postoperative pain and its as sociated neuroendocrine sequelae, major surgical procedures in traditi onally unsuitable patients can be seriously considered.