Analgésie aiguë du grand vieillard et du centenaire : principes généraux et cas particulier de la gestion de la douleur postopératoire

The management of postoperative pain in frail elderly patients (notably centenarians) is still a weak point in healthcare establishments. Older patients have coexisting diseases and concurrent medications (that may interfere with pain assessment or pain treatment), diminished functional status and physiological reserve and age-related pharmacodynamic and pharmacokinetic changes. Pain assessment presents numerous problems arising from differences in reporting cognitive impairment and difficulties in measurement. Healthcare professionals remain too reticent about evaluating pain in elderly patients and using sophisticated analgesic techniques (PCA, regional anesthesia). Opioids are underused and multimodal analgesia (including paracetamol) are still in its infancy. Although titration (from a pharmacological point of view) is essential, it is still necessary to adjust treatments to the patient's history, physiological age and the circumstances, which gave rise to the surgical procedure.