title: Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients: A Retrospective Analysis of 10,575 Patients.
abstract: In this retrospective analysis of 10,575 patients who used fentanyl-based intravenous patient-controlled analgesia (IV-PCA) after surgery, we evaluated difference between young and elderly patients on their characteristic of adverse effects.We reviewed the data collected from the patients who were provided IV-PCA for pain control following elective surgery under either general or spinal anesthesia between September 2010 and March 2014. Postoperative pain, incidence of PCA-related adverse effects, and risk factors for the need of rescue analgesics and antiemetics for postoperative 48 hours were analyzed.Pain intensity (numerical rating scale [NRS]) at postoperative 6 to 12 hours (4.68 vs 4.58, P < 0.01) and incidence of nausea or vomiting (23.8% vs 20.6%, P < 0.001) were higher in young patients, while incidence of PCA discontinuation (9.9% vs 11.5%, P < 0.01) and sedation (0.1% vs 0.7%, P < 0.001) was higher in elderly patients. Despite larger fentanyl dose used, a greater proportion of young patients required rescue analgesics (53.8% vs 47.9%, P < 0.001) while addition of ketorolac was effective in reducing postoperative pain. Despite lower incidence of postoperative nausea and vomiting (PONV), a larger proportion of elderly patients required rescue antiemetics (10.1% vs 12.2%, P < 0.001) while addition of ramosetron was effective in reducing PONV.In conclusion, when fentanyl-based IV-PCA is used for postoperative pain control, a larger proportion of young patients may require rescue analgesics while elderly patients may require more rescue antiemetics. The addition of ketorolac or ramosetron to the PCA of young and elderly patients can be effective to prevent rescue analgesics or antiemetics use.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (JCK, SYK, SC); and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea (JL).
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Koh
authors.forename: Jinae
authors.initials: J
authors.lastname: Lee
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Sumin
authors.initials: S
authors.lastname: Choi
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Han
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage; D001562:Benzimidazoles / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D001562:Benzimidazoles; C071315:ramosetron; D005283:Fentanyl; D020910:Ketorolac