Acute pain management in the elderly patient

MacIntyre, P A; Upton, Richard N.

doi:10.1201/b13460-33

Cited by 1 publication

(5 citation statements)

References 29 publications

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“…There was no difference in postoperative analgesic requirements following use of millimetre wave therapy after total knee arthroplasty (Usichenko, Edinger et al, 2008 Level II) or healing touch after coronary artery bypass surgery (MacIntyre et al, 2008 Level II), although postoperative anxiety was significant reduced in the latter study.…”

Section: Other Therapiesmentioning

confidence: 65%

“…The decrease is much greater than would be predicted by agerelated alterations in physiology and seems to have a significant pharmacodynamic component (Macintyre & Upton, 2008).…”

Section: Opioid Dosementioning

confidence: 72%

“…There is clinical and experimental evidence of a two-fold to four-fold decrease in opioid requirements as patient age increases (Burns et al, 1989 This age-related decrease in opioid requirement is due mainly to differences in pharmacodynamics or brain penetration rather than systemic pharmacokinetic factors (Scott & Stanski, 1987;Minto et al, 1997;Macintyre & Upton, 2008) (see Section 11.2).…”

Section: Patient Agementioning

confidence: 99%

“…This is in agreement with the findings by Scott and Stanski (Scott & Stanski, 1987) that the sensitivity of the brain to fentanyl and alfentanil was increased by 50% in older people. It has been suggested that doses of fentanyl, sufentanil and alfentanil should all be reduced by up to 50% in older patients (Shafer, 1997); reductions in the doses of other opioids is also advised (Macintyre & Upton, 2008).…”

Section: Opioid Dosementioning

confidence: 99%

“…Combinations of a local anaesthetic and opioid are commonly used for epidural analgesia so it would seem reasonable to use lower infusion rates in older patients (Macintyre & Upton, 2008).…”

Section: Chapter 11mentioning

confidence: 99%

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Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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Section: Other Therapiesmentioning

confidence: 65%

“…The decrease is much greater than would be predicted by agerelated alterations in physiology and seems to have a significant pharmacodynamic component (Macintyre & Upton, 2008).…”

Section: Opioid Dosementioning

confidence: 72%