Patient Controlled Analgesia (PCA) in the Elderly-A Retrospective Study in the Medical Center

Although Patient-Controlled Analgesia (PCA) was a popular device for postoperative pain management, concerns about the potential complications and effectiveness of PCA utilities still exist in the old-age population. In the elderly, the analgesics delivery routes, surgical influences on the requirement of analgesics, and gender disparities in pain management are still important issues to clarify. Methods: 7176 patients receiving surgical treatment and PCA for postoperative pain were enrolled in this retrospective study. The patients were grouped according to their ages (＜60 years old for group A, others for group B). The postoperative complications related to PCA (vertigo, nausea, vomiting, skin itching, urine retention, improper motor or sensory blockage, and respiratory depression) and pain scores (visual analog scale VAS) in bed resting, moving and coughing were registered for at least three days postoperatively. Gender, surgical sites, and analgesics delivery route were also regarded as independent variables to predict analgesic requirement and effectiveness of pain relief. Results: The complication rates in both groups were acceptable (respiratory depression: 0.0% vs. 0.2%, p=0.134, vertigo: 23.6% vs. 19.7, p=0.022, nausea: 13.0% vs. 11.4%, p=0.231, vomiting: 10.5% vs. 16.6%, p=0.000, skin-itching: 1.8% vs. 1.9%, p=0.935, urine retention: 0.8% vs. 0.2%, p=0.034, improper sensory block: 0.8% vs. 1.3%, p=0.194, improper sensory block: 0.4% vs. 1.0%, p=0.082), and the pain relief effectiveness of PCA makes no significant difference in both groups (VAS in 1st day, bed resting: 22.7±15.0 vs. 21.7±12.5, p=0.146, moving: 51.5±17.4 vs. 52.6±15.5, p=0.177, coughing: 62.3±19.2 vs. 60.1±18.5, p=.128). The analgesic requirements were significant higher in the young than in the elderly (morphine in mg/kg, 0.35±0.22 vs. 0.31±0.22, p=0.000). The surgeries involved upper abdomen demanded most analgesic, followed by surgeries on chest (1.4±1.1), lower abdomen (1.3±1.2), lower extremities (1.1±1.2), others (0.4±0.6), back (0.3±0.2) and upper extremities (0.2±0.1). The analgesics delivered through an epidural catheter produced far more effectiveness of pain relief than through an intravenous route (VAS in 1st postoperative day: bed resting: 22.3±14.0 vs. 13.0±15.0 p=0.000, moving: 51.9±16.7 vs. 35.3±19.9, p=0.000, coughing: 61.7±19.0 vs. 45.2.1±21.6, p=0.000). The gender disparities of pain perception in the elderly were also noted in this study (VAS in 1st postoperative day: bed resting: 17.4±13.6 vs. 19.2±13.9 p=0.043, moving: 45.2±19.2 vs. 47.9±18.6 p=0.030). Conclusions: PCA was a safe and effective maneuver for wound pain in the elderly. The PCA setting in these patients should consider the surgical sites, drugs delivery routes, age and gender.