An update on pain management for elderly patients undergoing ambulatory surgery.
OBJECTIVE
The aim of this review is to provide an overview of the drugs and techniques used for multimodal postoperative pain management in the older population undergoing surgery in the ambulatory setting.


RESULTS
Interest has grown in the possibility of adding adjuncts to a single shot nerve block in order to prolong the local anesthetic effect. The rapid and short-acting local anesthetics for spinal anesthesia are potentially beneficial for day-case surgery in the older population because of shorter duration of the motor block, faster recovery, and less transient neurologic symptoms. Another recent advance is the introduction of intravenous acetaminophen, which can rapidly achieve rapid peak plasma concentration (<15 min) following infusion and analgesic effect in ∼5 min with a duration of action up to 4 h.


CONCLUSIONS
The nonopioid analgesic therapies will likely assume an increasingly important role in facilitating the recovery process and improving the satisfaction for elderly ambulatory surgery patients. Strategies to avoid the use of opioids and minimize opioid-related side-effects is an important advance as we expand on the use of ambulatory surgery for the aging population.
aDepartment of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, USA bThe First Hospital of China Medical University, Shenyang, China cThe White Mountain Institute, The Sea Ranch, USA dPhoenix Thera-lase, Dallas, USA eInstituto Ortopedico Rizzoli, University of Bologna, Italy fDavid Geffen School of Medicine-UCLA, Los Angeles, USA gDrew University of Medicine and Science, Los Angeles, USA.
Xuezhao
X
Cao
Ofelia L
OL
Elvir-Lazo
Paul F
PF
White
Roya
R
Yumul
Jun
J
Tang
D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000698:Analgesia / Q000379:methods*; D000765:Anesthesia, Conduction / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal