Kosciuczuk Urszula, Talalaj Marcin, Rynkiewicz-Szczepanska Ewa
Department of Anaesthesiology and Intensive Therapy, Medical University of Bialystok, Kilinskiego Street 1, 15-276 Bialystok, Poland.
J Clin Med. 2025 Jun 20;14(13):4416. doi: 10.3390/jcm14134416.
: The use of opioid drugs in the elderly population is characterized by an increased risk of sedation and respiratory depression, and in the immediate postoperative period, it is associated with a higher incidence of postoperative delirium. The dilemma of opioid use as an element of acute postoperative pain therapy is crucial in elderly patients. This study was conducted in 80 patients qualified for laparoscopic cholecystectomy under general combined anesthesia. Two methods of analgesia were performed-Low-Opioid Analgesia (LOA) and Opioid-Based Analgesia (OBA)-and pain intensity based on the Numerical Rating Scale (NRS) was assessed at 0-2, 2-6, 6-12, and 12-24 h after surgery. The mean NRS in LOA and OBA was compared in age categories. Pain trajectory in patients over 60 years old was compared between LOA and OBA. : The trajectory of analgesia presented a negative slope in LOA for patients over 60 years of age, with reductions in pain intensity of 33%, 25%, and 66%. In OBA, a positive slope trajectory was noted, and pain intensity was higher within 12-24 h after surgery than within 0-2 and 2-6 h. : Opioid analgesia in patients over 60 years of age presented a better effect in the immediate postoperative period. Non-opioid analgesia is indicated for patients over 60 years old in the later postoperative period. The model of combined minimal opioid anesthesia and non-opioid postoperative analgesia presents a favorable therapeutic effect for patients over 60 years old.
阿片类药物在老年人群中的使用特点是镇静和呼吸抑制风险增加，且在术后即刻，其与术后谵妄的较高发生率相关。阿片类药物作为急性术后疼痛治疗要素的使用困境在老年患者中至关重要。本研究纳入了80例符合全身联合麻醉下行腹腔镜胆囊切除术条件的患者。实施了两种镇痛方法——低阿片类镇痛（LOA）和基于阿片类的镇痛（OBA），并在术后0 - 2小时、2 - 6小时、6 - 12小时和12 - 24小时根据数字评分量表（NRS）评估疼痛强度。比较了不同年龄组中LOA和OBA的平均NRS。比较了60岁以上患者在LOA和OBA之间的疼痛轨迹。60岁以上患者在LOA中的镇痛轨迹呈负斜率，疼痛强度降低了33%、25%和66%。在OBA中，观察到正斜率轨迹，且术后12 - 24小时内的疼痛强度高于0 - 2小时和2 - 6小时内。60岁以上患者的阿片类镇痛在术后即刻效果更好。60岁以上患者在术后后期适合使用非阿片类镇痛。联合最小剂量阿片类麻醉和非阿片类术后镇痛模式对60岁以上患者具有良好的治疗效果。
