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Current Anesthesiology Reports

29-09-2023 | Alzheimer's Disease | Anesthesia, Pain Management and Long-term Outcomes (VNR Gottumukkala and ER Mariano, Section Editors)

Postoperative Pain Management in Alzheimer’s Disease—a Review

Authors: Haania Shahbaz, Najwa Shakir, Sarush Ahmed Siddiqui, Syed Shujauddin, Rabbia Tariq, Arsalan Aamir Khan, Sadia Zaffar, Muhammad Faizan

Published in: Current Anesthesiology Reports

Abstract

Purpose of Review

Individuals with dementia and Alzheimer’s disease (AD) often receive inadequate analgesia compared to those without cognitive impairments [24-26]. However, undertreated pain contributes more to cognitive decline than analgesics. A comprehensive evaluation of available therapies considering administration modes, dosages, potential interactions, and side effects is necessary. Our review provides an extensive report on current methods of pain assessment, strategies for dealing with postoperative pain, and the challenges anesthesiologists face, and points out the inadequacy of current literature to formulate a comprehensive strategy.

Recent Findings

Trials have shown that for demented patients, there is a significant decrease in the dose of analgesia. Moreover, the ineffective assessment of the degree of pain leads to under-treatment. Studies are being conducted to assess validity of pain scales, current limitations, and suggestions to enhance their sensitivity.

Individualizing the opioid dose is vital for effective pain management in older adults. Multimodal analgesia can enhance pain relief and reduce opioid consumption and related adverse events.

Acetaminophen is a safe non-opioid option, while NSAIDs and centrally acting anticholinergics should be avoided due to potential toxicity. Among opioids, fentanyl, morphine, and oxycodone are considered safe, while pethidine and tramadol should be avoided due to their association with postoperative delirium.

Summary

Effective postoperative pain management in dementia patients requires individualized approaches, considering specific needs and risks associated with different drugs and administration methods. Certain medications may interact with analgesics and cause serious side effects in demented patients. Further research is necessary to establish guidelines for managing postoperative pain in Alzheimer’s disease.

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Title: Postoperative Pain Management in Alzheimer’s Disease—a Review
Authors: Haania Shahbaz
Najwa Shakir
Sarush Ahmed Siddiqui
Syed Shujauddin
Rabbia Tariq
Arsalan Aamir Khan
Sadia Zaffar
Muhammad Faizan
Publication date: 29-09-2023
Publisher: Springer US
Keywords: Alzheimer's Disease
Alzheimer's Disease
Dementia
Dementia
Opioids
Opioids
Postoperative Pain Management
Analgesics in Dentistry
Published in: Current Anesthesiology Reports
Electronic ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-023-00582-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative Pain Management in Alzheimer’s Disease—a Review

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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