Postoperative pain

There is debate as to the severity of postoperative pain in the older patient, since there is some suggestion that postoperative pain intensity reduces after the age of 60 years.23 A study using cannulation as a standardized clinical painful stimulus found both statistical and clinical reductions in pain in patients over 65 years.24 A study looking at morphine requirements postoperatively did not show a significant difference in reported pain score in the elderly compared to younger patients.25[III] The sex differences in morphine dose, with women requiring higher morphine doses to provide adequate analgesia, were not apparent in the elderly patients suggesting a hormonal influence on pain modulation in the postoperative setting.

Postoperative cognitive deficit is well recognized as a complication of surgery and may be more pronounced in the elderly population. Postoperative pain is considered to be one of the factors influencing this, and there may be particular concerns about the influence of analgesic techniques on postoperative cognition. A recent review of the postoperative pain literature showed pethidine (meperidine) to have a direct influence on cognitive deficit, but other commonly used postoperative opioids did not show significant effects on delirium or cognitive deficits and no differences were found between intravenous or epidural techniques. Further studies are required with sufficient power to detect a difference, as well as more standardized techniques.26[II]

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