# Trajectories of Pain in Low-Opioid and Opioid-Based Postoperative Analgesia in Older Patients—Perioperative Clinical Study

## TL;DR

This study compares pain management in older patients using low-opioid and opioid-based analgesia after surgery.

## Contribution

The study identifies distinct pain trajectories in older patients using low-opioid versus opioid-based analgesia.

## Key findings

- Low-Opioid Analgesia showed decreasing pain intensity in patients over 60 years.
- Opioid-Based Analgesia showed increasing pain intensity in the later postoperative period.
- Combined minimal opioid and non-opioid analgesia is favorable for older patients.

## Abstract

Background/Objectives: The use of opioid drugs in the elderly population is characterized by an increased risk of sedation and respiratory depression, and in the immediate postoperative period, it is associated with a higher incidence of postoperative delirium. The dilemma of opioid use as an element of acute postoperative pain therapy is crucial in elderly patients. Methods: This study was conducted in 80 patients qualified for laparoscopic cholecystectomy under general combined anesthesia. Two methods of analgesia were performed—Low-Opioid Analgesia (LOA) and Opioid-Based Analgesia (OBA)—and pain intensity based on the Numerical Rating Scale (NRS) was assessed at 0–2, 2–6, 6–12, and 12–24 h after surgery. The mean NRS in LOA and OBA was compared in age categories. Pain trajectory in patients over 60 years old was compared between LOA and OBA. Results: The trajectory of analgesia presented a negative slope in LOA for patients over 60 years of age, with reductions in pain intensity of 33%, 25%, and 66%. In OBA, a positive slope trajectory was noted, and pain intensity was higher within 12–24 h after surgery than within 0–2 and 2–6 h. Conclusions: Opioid analgesia in patients over 60 years of age presented a better effect in the immediate postoperative period. Non-opioid analgesia is indicated for patients over 60 years old in the later postoperative period. The model of combined minimal opioid anesthesia and non-opioid postoperative analgesia presents a favorable therapeutic effect for patients over 60 years old.