老年人術後疼痛管理之文獻回顧

Postoperative Pain Management for Geriatrics--A Brief Review Focused on Administering Drugs and Providing Nerve Block

人口高齡化是當今每個國家共同面對的問題，估計全世界超過65歲的老年人口數將從2008年約506萬人，在2040年增加到1.3億人。老年人在手術和非手術情況，疼痛未接受治療是非常普遍，將導致發展成慢性疼痛問題，並延遲他們功能恢復或是延長醫療照護，最後增加生活的負擔。值得關注老年人手術後疼痛問題經常無法被辨認且正確地控制。為了解決此問題，在手術前使用廣泛性老人評估（CGA），預測手術後合併症已經是被建議使用。其它評估工具，臉譜量表（Faces Pain Scale）疼痛評估已證實用於特別是有認知受損的老年人。老年病患通常合併複雜內科疾病，需要多重藥物治療包括嗎啡類和非嗎啡類藥物。根據美國藥物疼痛管理指引，在手術後期間有重度和中度疼痛，嗎啡類藥物應視為第一線用藥，但應合併非嗎啡類輔助藥物使用。在老年人手術後疼痛控制是很合理使用多種模式止痛，特別是用於神經阻斷術去減輕嚴重疼痛問題。由於人口老化，這些疼痛治療降低他們疼痛問題並改善全面性照護品質。

An aging population is a crucial issue faced by many countries. The number of people over 65 years old was estimated to be 5.06 million in 2008 and will increase to 130 million by 2040 worldwide. Pain during the treatment of the elderly is very common in surgical and non-surgical conditions. It can develop into chronic pain, delay functional recovery, prolong medical care, and increase life burden. Therefore, it is worthwhile to notice pain problems in the elderly that are often unrecognized and poorly controlled. To solve this problem, it is recommended to predict postoperative morbidity using a comprehensive geriatric assessment in the preoperative period. The Face Pain Scale has been verified for the evaluation of pain assessment, especially for older adults with cognitive impairment. Elderly patients usually have complex medical conditions that require polypharmacy that includes opioid/no-opioid drugs. According to the US Drug Pain Management Guidelines, opioids should be the first consideration. They should be combined with non-opioid adjuvants for moderate to severe postoperative pain. It is also reasonable to use multimodal analgesia in geriatric populations for postoperative pain control, especially neurological blockade to relieve severe pain. For geriatric populations, these treatments decrease pain and improve overall quality of care.