SUMMARY OF CONSENSUS: 1. The use of opioids in cancer pain: The criteria for selecting analgesics for pain treatment in the elderly include, but are not limited to, overall efficacy, overall side-effect profile, onset of action, drug interactions, abuse potential, and practical issues, such as cost and availability of the drug, as well as the severity and type of pain (nociceptive, acute/chronic, etc.). At any given time, the order of choice in the decision-making process can change. This consensus is based on evidence-based literature (extended data are not included and chronic, extended-release opioids are not covered). There are various driving factors relating to prescribing medication, including availability of the compound and cost, which may, at times, be the main driving factor. The transdermal formulation of buprenorphine is available in most European countries, particularly those with high opioid usage, with the exception of France; however, the availability of the sublingual formulation of buprenorphine in Europe is limited, as it is marketed in only a few countries, including Germany and Belgium. The opioid patch is experimental at present in U.S.A. and the sublingual formulation has dispensing restrictions, therefore, its use is limited. It is evident that the population pyramid is upturned. Globally, there is going to be an older population that needs to be cared for in the future. This older population has expectations in life, in that a retiree is no longer an individual who decreases their lifestyle activities. The "baby-boomers" in their 60s and 70s are "baby zoomers"; they want to have a functional active lifestyle. They are willing to make trade-offs regarding treatment choices and understand that they may experience pain, providing that can have increased quality of life and functionality. Therefore, comorbidities--including cancer and noncancer pain, osteoarthritis, rheumatoid arthritis, and postherpetic neuralgia--and patient functional status need to be taken carefully into account when addressing pain in the elderly. World Health Organization step III opioids are the mainstay of pain treatment for cancer patients and morphine has been the most commonly used for decades. In general, high level evidence data (Ib or IIb) exist, although many studies have included only few patients. Based on these studies, all opioids are considered effective in cancer pain management (although parts of cancer pain are not or only partially opioid sensitive), but no well-designed specific studies in the elderly cancer patient are available. Of the 2 opioids that are available in transdermal formulation--fentanyl and buprenorphine--fentanyl is the most investigated, but based on the published data both seem to be effective, with low toxicity and good tolerability profiles, especially at low doses. 2. The use of opioids in noncancer-related pain: Evidence is growing that opioids are efficacious in noncancer pain (treatment data mostly level Ib or IIb), but need individual dose titration and consideration of the...

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S-nrYBuprenorphine was given intravenously to produce analgesia in the immediate postoperative period, the dose being titratedagainst the response of each patient in order to obtain complete freedom from pain. In SO patients following lower segment Caesarean section under general anaesthesia, buprenorphine in the dose range 0.4-7.0 mg was found to be a potent, long lasting and safe analgesic. Serial blood gas estimations performed on ten of the patients confkmed the clinically observed lack of respiratory depression. Key wordsAnalgesic, narcotic; buprenorphine. Analgesia; postoperative. Anaesthesia; obstetric.The primary aim of postoperative analgesic medication is to provide relief from pain in every patient following surgery. The failure to achieve this is frequently due to the use of agents of inadequate analgesic potency, incorrect dosage and inappropriate route of administration. The intravenous route allows complete analgesia to be produced rapidly and the dose of the agent can be titrated against the response of the patient, thus eliminating the administration of too low or too high a dose and the occurrence of undesirable side-effects. This would be the optimal way in which to give analgesic drugs in the iminediate postoperative period. Buprenorphine, an oripavine derivative of thebane, is a recently introduced analgesic of the partial agonist-antagonist type. Its high potency and long duration of action together with a low incidence of side-effects indicate that it might be an ideal agent for use in the postoperative period. It was to investigate this concept that the study described here was initiated. MethodFifty female patients, of average age 27.5 years, were selected for study. They all underwent elective lower segment Caesarean section under general anaesthesia and were given buprenorphine in the immediate postoperative period to control their abdominal pain. All patients were given magnesium trisilicate 20 ml two hours before surgery and a second dose immediately before induction of anaesthesia. In addition, 18 patients received oral diazepam 20 mg and eighteen diazepam plus metoclopramide 10 mg two hours pre-operatively. Eacfi patient received a standard anaesthetic following a 4-minute period of preoxygenation. With a lateral Forum 90 1 tilt being maintained, anaesthesia was induced with thiopentone 250 mg, and cricoid pressure was applied by an assistant. Suxamethonium 100 mg was given to facilitate intubation of the trachea with a cuffed tube. Anaesthesia was maintained with oxygen (40%) and nitrous oxide (600/,), and muscular relaxation with incremental doses of pancuronium bromide. Syntocinon was given as necessary after delivery of the infant and at the termination of surgery residual neuromuscular blockade was reversed with a mixture of neostigmine (5.0 mg) and atropine (1.2 mg) in divided doses.When spontaneous ventilation had been re-established and a response to spoken command obtained, the patient was taken to the recovery room, where pulse rate, arterial blood pressure and respirator...

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