POSTOPERATIVE ANALGESIA - SPECIFICITIES IN THE ELDERLY

The necessity of an adapted, optimal postoperative analgesia in the el derly is widely recognised. Reduced physiological capacities must be t aken into consideration during the perioperative period. Class I analg esics, such as paracetamol, are both safe and efficient, and can be us ed for basic analgesia. Non steroid anti-inflammatory drugs carry an i ncreased iatrogenic risk in the elderly. Their benefits should always be considered with regard to their risk. Their dosage should be decrea sed by 40-60% in comparison to the standard adult doses. Opioids, thou gh highly efficient, carry a higher risk of respiratory depression due to the increased sensitivity to this class of molecules in the elderl y. Doses must be reduced by 50% of the standard adult dose in order to limit adverse events while maintaining an equivalent level of analges ia. Patient-controlled and spinal opioid analgesia can be used in elde rly patients. However surveillance of both the state of consciousness and respiratory rate must be carried out hourly over a period ranging from 12 to 24 hours. Pulse oximetry can be of value. After orthopaedic surgery, perineural or peripheral analgesia should be favoured consid ering the excellent benefit-risk ratio. Close clinical monitoring is e ssential for providing safe and efficient analgesia in the elderly usi ng the techniques currently at our disposal. (C) 1998 Elsevier, Paris.