Del Tedesco Filippo, Sessa Flaminio, Xhemalaj Rikardo, Sollazzi Liliana, Dello Russo Cinzia, Aceto Paola
Dipartimento di Scienze dell'emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
Saudi J Anaesth. 2023 Oct-Dec;17(4):491-499. doi: 10.4103/sja.sja_643_23. Epub 2023 Aug 18.
The administration of analgesic drugs in elderly patients should take into account age-related physiological changes, loss of efficiency of homeostatic mechanisms, and pharmacological interactions with chronic therapies. Underestimation of pain in patients with impaired cognition is often linked to difficulties in pain assessment. In the preoperative phase, it is essential to assess the physical status, cognitive reserve, and previous chronic pain conditions to plan effective analgesia. Furthermore, an accurate pharmacological history of the patient must be collected to establish any possible interaction with the whole perioperative analgesic plan. The use of analgesic drugs with different mechanisms of action for pain relief in the intraoperative phase is a crucial step to achieve adequate postoperative pain control in older adults. The combined multimodal and opioid-sparing strategy is strongly recommended to reduce side effects. The use of various adjuvants is also preferable. Moreover, the implementation of non-pharmacological approaches may lead to faster recovery. High-quality postoperative analgesia in older patients can be achieved only with a collaborative interdisciplinary team. The aim of this review is to highlight the perioperative pain management strategies in the elderly with a special focus on intraoperative pharmacological interventions.
老年患者使用镇痛药时应考虑与年龄相关的生理变化、体内稳态机制效率的丧失以及与慢性治疗的药物相互作用。认知受损患者的疼痛被低估往往与疼痛评估困难有关。在术前阶段，评估身体状况、认知储备和既往慢性疼痛情况对于制定有效的镇痛方案至关重要。此外，必须收集患者准确的用药史，以确定其与整个围手术期镇痛方案之间可能存在的相互作用。在术中使用具有不同作用机制的镇痛药来缓解疼痛，是实现老年患者术后充分疼痛控制的关键步骤。强烈建议采用联合多模式和减少阿片类药物用量的策略以减少副作用。使用各种辅助药物也是可取的。此外，实施非药物方法可能会加快康复。只有通过跨学科协作团队才能实现老年患者高质量的术后镇痛。本综述的目的是强调老年患者围手术期的疼痛管理策略，特别关注术中的药物干预。
