How To Manage Surgical Pain In Elderly Patients

By Erwin Juda, DPM, R.Ph.

Pertinent Points On Other Agents

   Ketorolac is available in a parenteral formulation and is effective for the short-term management of moderately severe pain that requires analgesia at the opioid level for up to five days. One should reduce the dosage to 15 mg IV or 30 mg IM in those over the age of 65.    While nonacetylated salicylates, such as salsalate, diflunisal and choline magnesium salicylate, are weak COX-1 inhibitors that have been mentioned as alternatives, numerous clinicians have found them to be less efficacious than COX-2 inhibitors. Naproxen is among the most highly plasma protein bound of the NSAID group. Therefore, it poses a risk for drug displacement interactions with the multiple drug regimens in this age group. Due to the high propensity of CNS effects with indomethacin and the extremely long plasma half-life of piroxicam, using these medications as analgesics in the elderly is inappropriate.6,8,9

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