Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review

Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postope...

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Published inAnesthesia and analgesia Vol. 135; no. 2; pp. 290 - 306
Main Authors Wilson, Sylvia H., Wilson, P. Ryan, Bridges, Kathryn H., Bell, L. Hannah, Clark, Carlee A.
Format Journal Article
LanguageEnglish
Published United States Lippincott Williams & Wilkin 01.08.2022
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Abstract Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Nonopioid analgesics are broken down as followsmedications prescribed throughout the perioperative period (acetaminophen and nonsteroidal anti-inflammatory drugs), medications limited to the acute perioperative setting ( N -methyl-D-aspartate receptor antagonists, dexmedetomidine, dexamethasone, and local anesthetics), and medications to be used with caution in the geriatric patient population (gabapentinoids and muscle relaxants). Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials‚ and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia.
AbstractList Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Nonopioid analgesics are broken down as followsmedications prescribed throughout the perioperative period (acetaminophen and nonsteroidal anti-inflammatory drugs), medications limited to the acute perioperative setting ( N -methyl-D-aspartate receptor antagonists, dexmedetomidine, dexamethasone, and local anesthetics), and medications to be used with caution in the geriatric patient population (gabapentinoids and muscle relaxants). Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials‚ and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia.
Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Nonopioid analgesics are broken down as follows: medications prescribed throughout the perioperative period (acetaminophen and nonsteroidal anti-inflammatory drugs), medications limited to the acute perioperative setting ( N -methyl-D-aspartate receptor antagonists, dexmedetomidine, dexamethasone, and local anesthetics), and medications to be used with caution in the geriatric patient population (gabapentinoids and muscle relaxants). Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials‚ and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia.
Author Bell, L. Hannah
Wilson, Sylvia H.
Wilson, P. Ryan
Bridges, Kathryn H.
Clark, Carlee A.
AuthorAffiliation From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
AuthorAffiliation_xml – name: From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
Author_xml – sequence: 1
  givenname: Sylvia H.
  surname: Wilson
  fullname: Wilson, Sylvia H.
  organization: From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
– sequence: 2
  givenname: P. Ryan
  surname: Wilson
  fullname: Wilson, P. Ryan
– sequence: 3
  givenname: Kathryn H.
  surname: Bridges
  fullname: Bridges, Kathryn H.
– sequence: 4
  givenname: L. Hannah
  surname: Bell
  fullname: Bell, L. Hannah
– sequence: 5
  givenname: Carlee A.
  surname: Clark
  fullname: Clark, Carlee A.
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35202007$$D View this record in MEDLINE/PubMed
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Title Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review
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