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Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients: A Retrospective Analysis of 10,575 Patients

 Jae Chul Koh  ;  Jinae Lee  ;  So Yeon Kim  ;  Sumin Choi  ;  Dong Woo Han 
 MEDICINE, Vol.94(45) : e2008, 2015 
Journal Title
Issue Date
Adult ; Age Factors ; Aged ; Analgesia, Patient-Controlled/adverse effects* ; Analgesics, Opioid/adverse effects* ; Analgesics, Opioid/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Antiemetics/administration & dosage ; Benzimidazoles/administration & dosage ; Dose-Response Relationship, Drug ; Elective Surgical Procedures ; Female ; Fentanyl/adverse effects* ; Fentanyl/therapeutic use ; Humans ; Ketorolac/administration & dosage ; Male ; Pain Measurement ; Pain, Postoperative/drug therapy* ; Postoperative Nausea and Vomiting/epidemiology* ; Retrospective Studies
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Koh, Jae Chul(고재철)
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Lee, Jinae(이진애)
Choi, Sumin(최수민)
Han, Dong Woo(한동우) ORCID logo https://orcid.org/0000-0002-8757-663X
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