Practical guidelines on the postoperative use of patient-controlled analgesia in the elderly

Inadequate pain control after surgery is associated with adverse outcomes in elderly patients; for this reason, effective analgesia is an essential 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 affect the pharmacodynamic and pharmacokinetic properties of analgesic drugs. Patient-controlled analgesia (PCA) offers advantages over traditional intramuscular analgesia in this setting, because it provides the opportunity to tailor therapy to the individual, as opposed to the average, patient. Morphine is the most widely used, and presently the most suitable, drug for use in PCA in the elderly. Studies have indicated that, after acute pain has been brought under control, PCA should be initiated at a dose of 1 or 1.5mg per dose, with a lockout period of 5 to 7 min. Continuous background infusions of opioids are contraindicated. Education of patients and healthcare professionals alike is necessary to optimise the utility of PCA in older patients. In addition, every effort should be made to avoid the development of postoperative confusion, as this is associated with an increased risk of inefficient pain relief and its deleterious consequences. In summary, close monitoring and evaluation of the patient throughout the peri-operative periods is required to ensure the appropriate and successful use of PCA in elderly patients.