[Postoperative analgesia. Specificity in the elderly]

Abstract

The necessity of an adapted, optimal postoperative analgesia in the elderly is widely recognised. Reduced physiological capacities must be taken into consideration during the perioperative period. Class I analgesics, such as paracetamol, are both safe and efficient, and can be used for basic analgesia. Non steroid anti-inflammatory drugs carry an increased iatrogenic risk in the elderly. Their benefits should always be considered with regard to their risk. Their dosage should be decreased by 40-60% in comparison to the standard adult doses. Opioids, though highly efficient, carry a higher risk of respiratory depression due to the increased sensitivity to this class of molecules in the elderly. Doses must be reduced by 50% of the standard adult dose in order to limit adverse events while maintaining an equivalent level of analgesia. Patient-controlled and spinal opioid analgesia can be used in elderly 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 considering the excellent benefit-risk ratio. Close clinical monitoring is essential for providing safe and efficient analgesia in the elderly using the techniques currently at our disposal.