Severity of pain, systemic side effects of narcotics, or concomitant co-morbidities may preclude the use of high doses of narcotics to control moderate-to-severe pain. Reversibly inhibiting the transmission of pain pathways at the level of the spinal cord or nerve, by neuraxial or peripheral nerve blocks, respectively, would alleviate pain. Neuro-axial administration of opioids, low dose local anesthetics and in combinations with systemic administration of alpha-2 agonists, NMDA antagonists can effectively control moderate to severe pain. In the elderly, these techniques and medications can be used to reduce the systemic doses of opioids and other analgesic medications. Spinal and epidural blocks can be very effective in relieving perioperative pain. However, elderly patients are more prone to hypotension produced by the concomitant sympathetic block when neuraxial local anesthetics are used (Meyhoff et al. 2007). Seemingly normal adult doses of opioids, benzodiazepines can cause respiratory depression and mental status changes in elderly debilitated patients. Smaller doses of local anesthetics and opioids are recommended in the elderly.
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