Postoperative Pain In Elderly Patients Research Articles

Effect of subanesthetic dose of esketamine on postoperative pain in elderly patients undergoing laparoscopic gastrointestinal tumor Surgery:A prospective, double-blind, randomized controlled trial

PurposePostoperative pain is prevalent and severe complication in elderly surgical patients. Multiple studies propose that a small dose of esketamine administered intraoperatively can alleviate postoperative pain and curtail opioid usage. We aimed to evaluate the impact of esketamine on postoperative acute pain among elderly patients with gastrointestinal tumors. Patients and methodsThis is a prospective, parallel-group, randomized controlled trial. Ninety patients aged 60 and above, undergoing resection of gastrointestinal tumors, were randomly assigned to two groups: esketamine group (Group S, a single dose of 0.25 mg/kg and 0.1 mg/kg/h infusion) and control group (Group C, saline). Visual Analogue Scale (VAS) pain scores were the primary outcome. Remifentanil consumption, instances of rescue analgesia, delirium, sleep quality, postoperative recovery quality, serum levels of inflammatory cytokines, and adverse events within 72 h post-surgery were secondary outcomes, respectively. ResultsData of 87 of 99 eligible patients were analyzed. VAS scores at rest in Group S were lower than those in Group C at 6 h [1.2 (0.6, 1.6) vs 1.6 (1.0, 2.0), P = 0.003], 12 h [1.4 (1.0, 2.0) vs 2.0 (1.5, 2.0), P < 0.001], and 24 h [1.8 (1.3, 2.0) vs 2.2 (1.6, 2.6), P < 0.001] postoperatively. At 6 h post-surgery, VAS score during coughing was lower in Group S than Group C [2.0 (2.0, 2.3) vs 2.0 (2.0, 3.0), P = 0.009]. The instances of rescue analgesia were fewer in group S compared to group C (P = 0.007). Furthermore, the esketamine group showed improved sleep quality and QoR-15 score (P < 0.05) postoperatively. ConclusionIntravenous administration of esketamine as an adjunct to general anesthesia can decrease the intensity of pain for 24 h without additional adverse effects after laparoscopic gastrointestinal tumor surgery.

The effect of parecoxib sodium combined with perioperative psychological care on postoperative pain in elderly patients with hip fractures.

This study aimed to investigate the effect of parecoxib sodium combined with perioperative psychological nursing on postoperative pain in elderly patients with hip fractures. 80 elderly patients with hip fractures who received surgical treatment in our hospital were selected as the research subjects. According to the different interventions received by the patients, they were divided into a control group (CG) (n=40) who received intravenous parecoxib sodium intervention before surgery, and an observation group (OG) (n=40) who received perioperative psychological nursing intervention in addition to the intervention received by the CG. The pain status, psychological status, hip joint function, daily living ability level, and quality of life of the two groups were compared. After surgery, the VAS score, SAS score and SDS score of the OG were lower than those of the CG (p < 0.05). After surgery, the Harris score of the OG was higher than that of the CG (p < 0.05). Before surgery, there was no significant difference in the Barthel index and SF-36 score between the two groups (p > 0.05). After surgery, the Barthel index and SF-36 scores of both groups showed a significant improvement compared to before surgery, and the scores in the OG were higher than those in the CG (p < 0.05). Perioperative psychological nursing combined with preemptive analgesia of parecoxib sodium has a significant positive effect on elderly patients with hip fractures after surgery. The combined nursing intervention can further alleviate postoperative pain, improve patients' psychological status, promote the recovery of hip joint function, and significantly improve the daily living ability and quality of life of patients. The combined intervention plan is worthy of clinical promotion and application.

Could epidural analgesia be safely used for acute postoperative pain in older adults to enhance recovery?

Epidural analgesia is often considered cornerstone in multimodal analgesia when used in major surgeries. However, its role in managing acute postoperative pain in elderly patients is debatable because of its known potential complications. Furthermore, postoperative pain in elderly patients is under-treated because of complex comorbidities, and they are more prone to adverse events related to pain therapies. All systemic analgesic drugs have pharmacological limitations and precautions in elderly people. Recent meta-analyses showed that epidural analgesia provided better postoperative pain control compared to intravenous opioids. Interestingly, peripheral nerve blocks had no superior control of pain over epidural analgesia. In addition, epidural analgesia has shown to positively affect perioperative morbidities and mortalities, and reduce opioid-related side effects because of its non-analgesic effects on each organ system. When tailored in a specific multimodal approach, it shortens the intensive care and hospital stays. In conclusion, if complications are identified and treated early, and contraindications are ruled out, epidural analgesia can achieve sufficient postoperative pain management with insignificant adverse events in this population.

Effects of Nalbuphine Combined with Anterior Serratus Plane Block in Elderly Patients Undergoing Thoracoscopic Surgery.

Postoperative pain in elderly patients with lung cancer after thoracoscopic surgery is still an important factor affecting the prognosis of patients. In this study, 200 elderly patients with lung cancer who were positive and planned to undergo video-assisted thoracoscopic surgery were randomly divided into four groups: control group, SAPB (serratus anterior plane block) group, Nalbuphine group and Nalbuphine + SAPB group. The effects of drugs and nerve block on the perioperative indexes of elderly patients were observed. The results showed that ① The VAS and SAS scores of postoperative analgesia in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ② The postoperative spontaneous respiratory recovery time, extubation time, resuscitation room stay time, extubation cough, restlessness and respiratory depression in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ③ The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and blood oxygen saturation (SpO2) of patients in Nalbuphine + SAPB group before induction, T2 after intubation, T3 before skin incision, T4 after skin incision, T5 after chest closure and T6 after extubation were lower than those in single group and control group. Therefore, this study concluded that Nabufine combined with SAPB can make the vital signs of intraoperative patients more stable, which is worthy of clinical promotion.

A Bibliometric Analysis of Published Literature in Postoperative Pain in Elderly Patients in Low- and Middle-Income Countries.

Postoperative pain (POP) remains a major challenge for surgeons and anesthesiologists worldwide, especially in low- and middle-income countries. Elderly patients are at higher risk for undertreatment of pain. Despite that, there is a paucity of papers addressing POP among this population in developing countries. This study aimed to provide a bibliometric analysis of the literature concerning postoperative pain in elderly patients from low- and middle-income countries. It was performed an extensive search of papers on this subject through the Web of Science and Scopus database using a series of uniterms and, including publications from 2001 to 2021. Publication quality was assessed by using total citation frequency, average citations per item and other citation indexes. Citation indexes were low, with the highest reaching 15 citations. In conclusion, few studies of postoperative pain in the elderly in countries with medium and low income, indicating a need that has not yet been met for this population and in these areas of the world. The published studies were not specifically aimed at the elderly, had limited impact, low international visibility. They were not epidemiological studies and are not robust, weakening knowledge and decision-making towards policies directed at this vulnerable population.

Pharmacokinetics of ropivacaine in elderly patients receiving fascia iliaca compartment block.

Local anesthetic of ropivacaine was demonstrated to reduce the postoperative pain in elderly patients. This study investigated the pharmacokinetics of ropivacaine at different concentrations in elderly patients subjected to fascia iliaca compartment block. Forty patients with femoral neck fracture at American Society of Anesthesiologists (ASA) I–II status, undergoing fascia iliaca compartment block (FICB) were randomized to two groups receiving 0.7 ml/kg of solution containing 0.375% ropivacaine (group L) or 0.5% ropivacaine (group H). Samples of venous blood were obtained immediately at different time points after FICB, and the total and free plasma concentrations of ropivacaine were measured by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). Statistical analysis was carried out using a pharmacokinetic calculation program (DAS 3.0). Visual Analogue Scale (VAS) scores were significantly decreased after FICB in both groups, and VAS score in group H was lower compared with group L. The total maximum plasma concentration (Cmax) and the free Cmax of ropivacaine in group H was higher than that in group L (P<0.05). The decrease of the total and free plasma concentration was operation time-dependent. Neither group showed signs of central nervous system and circulatory system toxicity. On the basis of these results, the concentrations of 0.375 and 0.5% ropivacaine held an efficiently analgesic effect for FICB, suggesting that ropivacaine can be employed in analgesic therapy. However, both concentrations have a potentially theoretical risk of local anesthetics poisoning, suggesting that a lower concentration may be a safer option for a single large volume of FICB.

Analysis of reliability and validity of Chinese version software for pain assessment among elderly patients after surgery

Objective To evaluate the reliability and validity of Chinese version software for pain assessment, so as to provide an instrument for postoperative pain assessment in elderly. Methods We strictly revised and translated the software for pain assessment into Chinese version according to the program of translation-back translation-cultural adaptation-pre experiment. From June to July 2015, 98 elderly patients who would undergo surgery were selected as the research object, and they were evaluated by pain score to test the reliability and validity. Results Pain assessment software extracted a total of 20 items of 5 common factors including tranquillization, bed activity, eating, deep breathing and cough by principal component analysis (PCA) , which could explain 80.184% of total variances. The Correlated coefficients between each dimension and faces pain scale (FPS) and numerical rating scale (NRS) were between 0.586-0.933. The Cronbach′s α coefficient was 0.912 for the total scale. Conclusions The pain assessment software has good performance, high reliability and high validity. It can be used to evaluate the reliability of postoperative pain in elderly patients. Key words: Aged; Pain assessment; Assessment software; Reliability; Validity

Clinical study on the safety and efficacy of dezocine combined with flurbiprofen axetil in postoperative analgesia in elderly patients undergoing upper abdominal surgery

Objective To explore the safety and efficacy of dezocine combined with flurbiprofen axetil in postoperative analgesia in elderly patients undergoing upper abdominal surgery. Methods 80 patients underwent abdominal surgery were selected.They were divided into study group(T group) and control group(C group) according to the random number table, 40 cases in each group.The visual analogue scale(VAS) and Ramsay sedation score were recorded at 2h, 6h, 12h, 24h, 48h after operation, respectively.The anesthesia-related complications such as sleepiness, chills, postoperative nausea and vomiting(PONV), and pulmonary infection in 48 hours were also recorded. Results There were no statistically significant differences in the VAS score between the two groups in the resting state and the active state(t=0.287, 0.436, all P>0.05). The VAS scores of T group were significantly lower than those of C group at 2h, 6h, 12h, 24h and 48h after operation(t=4.096, 4.241, 5.510, 6.121, 5.752, 3.542, 3.866, 4.948, 5.542, 4.030, all P 0.05). There were no statistically significant differences in the incidence of drowsiness, chills, PONV, skin itching and pulmonary infection in the two groups(4 cases vs.6 cases, 6 cases vs.5 cases, 5 cases vs.3 cases, 1 case vs.3 cases, 5 cases vs.1 case, P=0.499, 0.712, 0.745, 0.615, 0.201). Conclusion The postoperative analgesic compatibility of dezocine combined with flurbiprofen axetil can effectively relieve the postoperative pain in elderly patients with upper abdominal surgery and provide good postoperative analgesic effect and does not increase the incidence of drug related complications.It is worth to promote in clinical. Key words: Surgical proceduresoperative; Abdomen; Analgesia; Dezocine; Flurbiprofen axetil; Aged

Patient Empowerment Reduces Pain in Geriatric Patients After Gynecologic Onco-Surgery: Subgroup Analysis of a Prospective Randomized Controlled Clinical Trial

This study aimed to determine the effect of patient empowerment on acute postoperative pain. This research was part of the Patient Empowerment and Risk-Assessed Treatment to Improve Outcome in the Elderly After Onco-Surgery Trial. This research was a prospective randomized controlled interventional study. Patients who underwent gynecologic onco-surgery were included in this analysis of demographic data, basic characteristics, pain intensity by numeric rating scale, and mode of pain therapy. The intervention included provision of detailed information booklet and patient diary. Ninety-one patients were enrolled (treatment group, n=51; control group, n=40). With the same medications, pain on the first postoperative day was significantly less severe in the treatment group than in the control group (P=.03). On multivariate logistic regression, patient empowerment had a significant effect on pain intensity (odds ratio, 3.46; 95% confidence interval, 1.35 to 8.86; P=.01). The number needed to treat to decrease pain from severe to mild (numeric rating scale, 5 to 10 to 0 to 4) was 4.35. Patient empowerment significantly reduces postoperative pain in elderly patients undergoing gynecologic cancer surgery.

Correlation between preoperative anxiety and acute postoperative pain in elderly patients submitted to transvesical prostatectomy

ABSTRACT BACKGROUND AND OBJECTIVES: The objective of this study was to correlate the level of anxiety presented in the preoperative period with the intensity of pain reported by elderly in the immediate postoperative period of transvesical prostatectomy. METHODS: Sixty-four elderly patients submitted to transvesical prostatectomy were studied, using the following instruments: the numeric pain scale and Hamilton anxiety rating scale in the preoperative; and the short-form McGill pain questionnaire (Portuguese version adapted) in the immediate postoperative period. The elderly divided into four groups, according to the level of anxiety presented in the preoperative period: absent, mild, moderate and intense. The Spearman correlation was established between preoperative anxiety levels and postoperative pain intensity. RESULTS: There was a significant positive correlation between the level of preoperative anxiety and pain intensity in the immediate postoperative period. The pain curves (sensitive and affective) presented a significant increase at moments 6, 18 and 24h in all groups. These curves were significantly higher in the elderly with moderate and intense anxiety than in those without anxiety and mild anxiety. The pain peak was recorded at 18h after surgery in all groups. CONCLUSION: In the elderly, the level of anxiety presented in the preoperative period was positively correlated with the pain response in the immediate postoperative of transvesical prostatectomy. The use of preoperative measures that reduce anxiety can improve analgesia in the immediate postoperative period of this surgery and, therefore, reduce the amount of analgesics used in this period. There was also a need for intervention with adequate analgesia at the postoperative pain peak which occurred 18h after surgery.

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients.

Elderly patients are often considered as high-risk for major abdominal surgery due to reduced functional reserve and increased comorbidities. We herein evaluated the efficacy of totally laparoscopic distal gastrectomy (TLDG) in elderly patients with gastric cancer by measuring the postoperative systemic responses and postoperative analgesic consumption. A total of 102 patients with gastric cancer [57 who underwent TLDG and 45 who underwent laparoscopy-assisted distal gastrectomy (LADG)] were enrolled in this study. The patients were classified as elderly (aged ≥75 years) and non-elderly (aged <75 years) groups. The surgical outcome and postoperative analgesic consumption were evaluated. The elderly group exhibited a higher incidence of comorbidities and a longer postoperative hospital stay compared with those of younger patients, although there was no difference in the incidence of postoperative complications. In addition, the total consumption of additional analgesics until postoperative day 5 in patients who underwent TLDG was significantly lower compared with that in patients who underwent LADG in the elderly group; there was no such difference in the non-elderly group. The results suggested that TLDG was better for the management of postoperative pain in elderly patients with gastric cancer, who exhibit the highest mortality rates in the adult surgical population.

Identification and Comparison of Barriers to Assessing and Combating Acute and Postoperative Pain in Elderly Patients in Surgical Wards of Polish Hospitals: A Multicenter Study

Inadequate pain monitoring and management in hospitalized patients poses a serious clinical problem which has been extensively covered in literature for over 25 years. The purpose of the paper was to learn about and compare the existing barriers to effective analgesia controlled by nurses on surgical wards in Polish hospitals. The study was carried out upon the approval of the study protocol by the Independent Bioethics Committee for Scientific Research of the Medical University of Gdańsk. The research project was multi-center and took a year. The study was questionnaire-based. It used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1300 nurses working on surgical wards. The barriers most frequently observed by the respondents were: disorganization of the healthcare system, physicians' mistrust of pain assessment by nursing staff, difficulty contacting and communicating with physicians to discuss the results of patients' pain assessments and difficulties experienced by elderly patients with completing pain assessment scales. The barriers most frequently impeding pain therapy in elderly patients are associated with the healthcare system, and they were more frequently present on the anesthesiology and intensive care ward and in the emergency department, and occurred the least frequently on the surgical ward. Patient-related problems were more frequent on the anesthesiology and intensive care wards than in the emergency department. Doctor-related problems most frequently occurred on the gynecological ward, while nurse-related problems were more frequent on the anesthesiology and intensive care ward.

The Algoplus Score to Assess Acute Postoperative pain in Elderly patients–A Pilot Observational Study

Standard verbal or analogue scales may not be accurate to assess acute postoperative pain in elderly patients. This study was designed to field test the Algoplus tool, developed specifically for this population and based on observation of patient behavior. Prospective, observational cohort. Single center, French University hospital. Forty-eight patients, aged over 65, scheduled for surgery under general anesthesia, and observed on admission to the postanesthesia care unit, immediately after extubation, during the different steps of analgesic intervention (demand, relief with intravenous opioid titration, plus intermediate measures when relevant), and either at discharge or 3 hours after admission. A numerical rating scale (NRS) was used to guide analgesia. The Algoplus score and the state of alertness or sedation were noted. NRS scores and Algoplus scores were significantly related, and both scores significantly decreased under the effect of analgesia, but the correlation was low. In early observations, the Algoplus score was higher than that predicted by the NRS score, in relation to residual sedation. Female gender tended to lower the Algoplus score compared to the NRS score. When the NRS score exceeded 3/10, indicating the need for analgesic intervention, the Algoplus score was generally lower than the recommended trigger for analgesia (2/5). These results are promising, but further evidence of a clinical benefit to the use of Algoplus for acute postoperative pain is needed. In future studies, scoring should be adjusted to take into account the time from extubation, the state of sedation, and the patient's gender in order to interpret results.

Implications of palonosetron in elderly patients undergoing laparoscopic cholecystectomy with respect to its anti-shivering effect.

The elderly are vulnerable to hypothermia and have a higher risk of cardiovascular events induced by marked increases in oxygen consumption due to shivering. Five-hydroxytryptamine-3 (5-HT3) receptor antagonists have been previously reported to reduce post-anesthesia shivering. In the present study, the authors investigated the effects of palonosetron, a new-generation 5-HT3 antagonist, on core hypothermia and the incidence of shivering after laparoscopic cholecystectomy in elderly patients. Forty-eight patients (65-80 years) were randomly assigned to one of two groups and administered palonosetron 0.075mg (palonosetron group, n=24) or the same volume of normal saline (control group, n=24) before anesthesia induction. Core body temperatures and hemodynamic variables were monitored during and after operation. Post-anesthetic shivering (PAS) and pain scores were obtained in a post-anesthetic care unit. Intraoperative esophageal temperature changed significantly over time (P=0.010), but significant intergroup difference in change was not observed (P=0.706). Furthermore, shivering frequencies were similar in the two groups (P=0.610). However, postoperative pain scores at 30min after entering the post-anesthesia care unit were significantly lower in the palonosetron group (P=0.002). Regardless of the previously reported anti-shivering effect of 5-HT3 receptor antagonists, pre-operative palonosetron 0.075mg did not influence perioperative hypothermia or PAS in this study. This discrepancy might be due to the dose responsiveness of palonosetron to PAS and relatively low incidence of PAS in the elderly. Pre-operative administration of palonosetron 0.075mg did not influence perioperative hypothermia or post-anesthesia shivering in elderly patients undergoing laparoscopic cholecystectomy. However, palonosetron might be beneficial for reducing early postoperative pain in elderly patients with opioid-based patient-controlled analgesia.

Perioperative psychological and music interventions in elderly patients undergoing spinal anesthesia: effect on anxiety, heart rate variability, and postoperative pain.

PurposeThe aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels.Materials and MethodsFourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music intervention, and the other was the control. The intervention group underwent psychological intervention and listening to music for 30 min before surgery.ResultsThe mean change in HRV as determined by low frequency (LF) power measurements. After the intervention, the ratio of mean LF to high frequency (HF) power decreased significantly in the intervention group compared to before the intervention (p<0.05). In the control group, mean LF measurements and the ratio of LF:HF did not change significantly. In the intervention group, mean HF power was significantly higher after the procedure than before (p<0.01). Moreover, the mean self-rating anxiety score of the intervention group decreased after the procedure compared to before (p<0.05). The mean visual analogue score of the intervention group 6 hours after surgery was significantly lower than that of the control group (p<0.01).ConclusionPerioperative psychological and music interventions can reduce anxiety and postoperative pain in elderly patients.

Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture

IntroductionHip fractures represent one of the most important causes of morbidity and mortality in elderly people. Anxiety and depression affect their quality of life and increase pain severity, and have adverse effects on functional recovery. Recent World Health Organization guidelines emphasize that therapeutic regimes need to be individualized and combined with psychological support. This study was launched with the primary endpoint of assessing if and to what extent client-centered therapy affects the perception of pain, reduces anxiety and depression, and increases the quality of life of elderly patients with hip fracture.Materials and methodsForty patients were admitted to the Orthopedic and Trauma Surgery ward for hip fracture. Patients were randomly divided into two subgroups: (1) case (group C), had to receive patient-centered counseling throughout the hospitalization; and (2) control (group NC), receiving the analgesic treatment without receiving counseling. Short Form-36-item Health Survey Questionnaire, State–Trait Anxiety Inventory, and Hamilton Rating Scale for Depression scores were recorded before any treatment, at discharge, and after 30 days. Pain levels were evaluated by means of Visual Analog Scale every 12 hours during the hospitalization from the day of surgery until day 5.ResultsThe hierarchical clustering analysis identified before any treatment were two clusters based on different physical functioning perceptions and role limitations, which were due to physical and emotional problems. Counseling did have a positive impact on quality of life on all patients, but in a more relevant way if patients were low functioning upon admittance to the ward. Anxiety and depression decreased in patients undergoing counseling, and their pain levels were lower than among patients not receiving it.ConclusionThis study reveals that hip fracture patients can be clustered on the basis of Short Form-36 baseline scores. Counseling affects the evolution of mental and physical status in these patients, and the major benefit is reported in patients whose quality of life perception is worse after the trauma. Decreasing anxiety and depression levels, as well as more satisfying pain management, assessed by means of specific tests, confirm the effectiveness of counseling in elderly patients with hip fracture.

With appropriate adjustment, most analgesic regimens can be used to manage postoperative pain in the elderly

Management of postoperative pain in elderly patients requires an individualized approach and careful patient evaluation. With appropriate adjustment for physiological changes, co-morbidities and concurrent medications, the majority of pharmacological agents, techniques and strategies available for relieving acute pain can be used in the elderly. Most regimens should ‘start low and go slow’ and include monitoring for adverse events.

The control of postoperative pain in elderly patients undergoing total hip replacement under spinal anesthesia

Background The hip replacement surgery is intended to reduce the intensity of joint pain and improve quality of life in patients with arthritic disease. Advanced age is not a limit to surgical treatment for subarachnoid anesthesia, which is well tolerated by elderly patients. The aim of our study is to assess how spinal anesthesia with hyperbaric bupivacaine and buprenorphine and the subsequent use of an elastomeric pump can contribute to postoperative pain control in this type of surgery.

Combined infusions of morphine and ketamine for postoperative pain in elderly patients

The value of using a combined infusion of morphine with a variable dose of ketamine for postoperative analgesia following upper abdominal surgery was assessed in a double-blind randomised study of 40 elderly patients. Four groups of 10 patients received an infusion of morphine at 1 mg.h-1, either alone, or combined with ketamine at a rate of 5, 10 or 20 mg.h-1. The addition of ketamine to a continuous infusion of morphine did not significantly improve either analgesia or postoperative lung function. Increasing the dose of ketamine resulted in an increased incidence of postoperative dreaming (p < 0.01).