Controlling postoperative pain in Ihe elderly can be difficult. The major goal of such control is paCieni comfort; a secondary goal is de¬creased morbidity and mortality. Adequate analgesia may improve car¬diovascular and pulmonary function. By preventing Ihe stress response to postoperative pain, adequate analgesia may also lower the incidence of postoperative myocardial events.
Much of the decrease in ventilatory function after thoracic and ab¬dominal surgeries results from surgical trauma and splinting from post¬operative pain. Postoperative analgesia cannot undo the decrease in ventilatory function produced by surgical trauma or lung resection. However, anesthesiologists and surgeons can help prevent splinting by providing adequate analgesia, thus helping patients breathe deeply and cough, improving mucous removal and avoiding atelectasis. Ry avoid¬ing atelectasis, patients also reduce the risk of postoperative pneumo¬nia and hypoxia.
Patients who receive adequate postoperative pain relief generally walk earlier and are discharged sooner than those who do not. Thus, adequate analgesia helps in achieving the overall goal of most surgical procedures: to return the patient to an improved functional state in the community, which benefits both Ihe patient and society. Also, by short¬ening the hospital stay, adequate analgesia reduces the cost of medical care.
To achieve postoperative analgesia, an anesthesiologist may use a narcotic, a nonsteroidal anti-inflammatory drug, or a regional anes-Ihelic method. Each choice has its advantages and disadvantages as a modality for analgesia in the elderly