Regional anesthesia for acute pain management in elderly patients

Table 2 List of older patient considerations related to regional anesthesia/analgesia

Indications	Contraindications
Poor cardiac reserve in patients who may not tolerate general anesthesia	Patient refusal
Poor pulmonary reserve: general anesthesia may result in prolonged mechanical ventilation	Sepsis, systemic infection and local infection are relative contraindications, and need to be assessed individually
Known history of adverse cognitive effects due to opioids and/or general anesthesia	Sedation and agitation may place patients at risk during PNB procedures
Severe hepatic insufficiency	Coagulopathy; relative contraindication with superficial PNB where bleeding can be easily controlled by compression
Severe renal insufficiency	Pre-existing neurological disease needs to be documented well and assess risk/benefit ratio
Difficult airway such as in elderly with cervical disk injury/pathology	Hypovolemia and severe aortic stenosis are relative contraindications for neuroaxial blocks, but not for PNBs
Chronic pain patients	Concern that PNB may mask compartment syndrome (controversial), however, collaboration between anesthesiologist and surgeon is necessary
Multiple rib fractures	Allergy to local anesthetics (rare)

PNB: Percutaneous needle biopsy.