Regional anesthesia for acute pain management in elderly patients

Abstract

Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia (RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient’s home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderly.

Keywords: Regional anesthesia; Elderly patients; Pain management; Local anesthetics; Opioid analgesics; Multi-modal; Cognitive impairment; Organ systems; Procedure- and patient-specific

Core tip: Perioperative advancements has made operating on the elderly more safe, however, aging involves functional reserve loss and older patients often present with co-morbidities. Regional may prove instrumental and permit operations on those who are not ideal candidates, reduce incidence of adverse effects, optimize pain control, provide medical care alternatives and may reduce financial impact on healthcare systems (early ambulation, shorter hospital stay). Understanding of aging, together with improvements in regional will make it safe to operate on the elderly with reduced morbidity and mortality. Regional plays an important role in pain control, decreases management complications and can reduce healthcare costs.