In this retrospective analysis of 10,575 patients who used
fentanyl-based intravenous
patient-controlled analgesia (IV-PCA) after surgery, we evaluated difference between young and elderly patients on their characteristic of adverse effects.We reviewed the data collected from the patients who were provided IV-PCA for
pain control following elective surgery under either general or
spinal anesthesia between September 2010 and March 2014.
Postoperative pain, incidence of PCA-related adverse effects, and risk factors for the need of rescue
analgesics and
antiemetics for postoperative 48 hours were analyzed.Pain intensity (numerical rating scale [NRS]) at postoperative 6 to 12 hours (4.68 vs 4.58, P < 0.01) and incidence of
nausea or
vomiting (23.8% vs 20.6%, P < 0.001) were higher in young patients, while incidence of PCA discontinuation (9.9% vs 11.5%, P < 0.01) and sedation (0.1% vs 0.7%, P < 0.001) was higher in elderly patients. Despite larger
fentanyl dose used, a greater proportion of young patients required rescue
analgesics (53.8% vs 47.9%, P < 0.001) while addition of
ketorolac was effective in reducing
postoperative pain. Despite lower incidence of
postoperative nausea and vomiting (
PONV), a larger proportion of elderly patients required rescue
antiemetics (10.1% vs 12.2%, P < 0.001) while addition of
ramosetron was effective in reducing
PONV.In conclusion, when
fentanyl-based IV-PCA is used for
postoperative pain control, a larger proportion of young patients may require rescue
analgesics while elderly patients may require more rescue
antiemetics. The addition of
ketorolac or
ramosetron to the PCA of young and elderly patients can be effective to prevent rescue
analgesics or
antiemetics use.