الفهرس 
Acknowledgement
Challenges of pain management in the elderly patientsOnly 14 pages are availabe for public view
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Abstract
Pain management in the elderly patients is difficult because they are more prone to adverse effects. Physiological and pharmacological changes favour the titration of medications during and after surgery. Furthermore, postoperative pain in elderly patients is usually under-treated because of complex comorbidities, and they are more prone to adverse events related to pain therapies. Pharmacologically, all systemic analgesic drugs have their limitations and precautions in the elderly people. In comparison with systemic opioids, epidural analgesia obviously provided better control of postoperative pain regardless of location of catheter placement, and type and time of pain assessment. Moreover, plexus blocks do not provide superior control of pain than epidural analgesia, but evaluation of the risk/benefit should be kept in mind. Protocols and recommendations, such as BEERS criteria and PROSPECT, should be used to avoid empirical treatment and reduce adverse effects. More studies that compare PNBs and epidural analgesia in the elderly patients are needed with focus of their non-analgesic effects. However, its role in managing acute postoperative pain in elderly patients has been debatable because of its known potential complications. Epidural analgesia has been shown to positively affect perioperative morbidities and mortalities, reduce opioid-related side effects because of their non-analgesic effects on each organ system. We concluded that epidural morphine 3 mg as a bolus every 24 hr, with add on IV patient control analgesia (PCA) morphine set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 minutes, is the balancing dose that achieves effective analgesia up to 72 hr postoperatively without increasing in the level of sedation or PONV in older adults after a lower abdominal cancer surgery. If special attention to its complication was paid and clear contraindications were ruled out, epidural analgesia can achieve sufficient postoperative pain management with unsignificant adverse events in this population shorten the intensive care and hospital stays.