Surgery in Elderly People

Pain control in older adults carries its own set of challenges. Compared with younger people, older adults typically experience and report less subjective pain. Conversely, they are more sensitive to any side effects of analgesics and narcotics. Monitoring of pulse, blood pressure, respiratory rate, and mental status are therefore important when administrating opiates. Adequate pain management should utilize a multidisciplinary approach involving anesthesia, acute-pain team services, and nursing and pharmacy support.

Adequate pain control is important for many reasons. A decrease in ventilatory function, partly due to splinting (the inability to take a deep breath due to incision discomfort), is often experienced after thoracic or upper abdominal surgery and is exacerbated if there is poor pain management. Pain management helps prevent splinting and thereby enables patients to breath deeply and expectorate more efficiently. This avoids atelectasis (microcollapse of lung tissue involved in respiration) and assists in clearing mucous secretions, which in turn reduces the postoperative risk of pneumonia and hypoxia. Conversely, an overdose of narcotic agents can reduce respiratory drive and level of consciousness, increasing the risk of delirium, hypoxia, and aspiration.

Pain management reduces circulating catecholamines (e.g., epinephrine and norepinepherine) released during the stress of surgery. This lessens cardiovascular demand, which is of particular importance in elderly people with coronary artery disease, in whom it can exacerbate postoperative myocardial ischemia and infarction.

Proper postoperative pain management helps patients walk and rehabilitate early and reduces the length of stay in an acute care setting. However, the response is highly variable between patients, and careful drug administration and individualization is necessary.