Age Is Not an Impediment to Effective Use of Patient-controlled Analgesia by Surgical Patients

Abstract

Background Obstacles to the use of patient-controlled analgesia (PCA) by elderly surgical patients have not been well-documented. Age differences in preoperative psychological factors, postoperative pain and analgesic consumption, treatment satisfaction, and concerns regarding PCA were measured to identify factors important to effective PCA use. Methods Preoperatively, young (mean age +/- SD, 39 +/- 9 yr; n = 45) and older (mean age +/- SD, 67 +/- 8 yr; n = 44) general surgery patients completed measures of attitudes toward and expectations of postoperative pain and PCA, psychological distress, health opinions, self-efficacy, and optimism. On the first 2 postoperative days, pain at rest and with movement and satisfaction with pain control were assessed using visual analog scales. Daily opioid intake was recorded. When PCA was discontinued, satisfaction and concerns about it were assessed. Results The older patients expected less intense pain (P </= 0.003) and preferred less information about (P </= 0.02) and involvement in (P </= 0.002) health care than young patients. There were no age differences with regard to pain at rest (P </= 0.22) or with movement (P </= 0.68). The older group self-administered less opioid than the young group (P </= 0.0001) and received PCA for more days than the young group (P </= 0.004). The groups did not differ in concerns about pain relief, adverse drug effects, including opioid addiction, and equipment use or malfunction. Satisfaction with PCA was high and did not differ between the groups. Conclusions Patient-controlled analgesia use was not hindered by age differences in beliefs about postoperative pain and opioids. Younger and older patients attained comparable levels of analgesia and were equally satisfied with their pain control.

Predictors of expectancies for post-surgical pain and fatigue in breast cancer surgical patients

“…This relationship is congruent with previous research which found older surgery patients to expect less intense post-surgical pain than younger patients (Gagliese, Jackson, Ritvo, Wowk, & Katz, 2000). In addition, our finding is consistent with a recent study of cancer patients about to begin treatment, in which patients over age 60 expected to experience fewer side effects during treatment than younger patients (Hofman et al, 2004).…”

Pharmacological treatment of neuropathic pain in older persons

“…The EFNS guidelines (Attal et al 2006) recommend their use as second-line treatment in a number of neuropathic pain conditions, but again no specifi c guidance is provided for their use in elderly patients. It is suggested that elderly patients may require less opioid than younger patients and in the post-operative setting there is evidence of an age-related 2-4 fold decrease in morphine and fentanyl requirements (Macintyre and Jarvis 1996;Woodhouse and Mather 1997;Gagliese et al 2000).…”

Influence of tobacco use on postoperative opiate analgesia requirements in patients undergoing coronary artery bypass graft surgery

“…Creekmore et al demonstrated that smokers undergoing coronary artery bypass graft surgery (CABG) required more postoperative opioids than nonsmokers (33% greater opioid requirements adjusted for body mass index). (11) Limitations of these studies (small sample sizes, heterogenous surgical populations, and others) precluded meaningful adjustment for variables such as age (13)(14)(15) and gender (16,17) which are known to strongly influence postoperative pain. Thus, the association between smoking and higher postoperative opiate requirements is unclear.…”