Pain evaluation in elderly patients after orthopaedic surgery under regional anaesthesia

The intensity of pain before and after orthopaedic surgery and the usefulness of several pain assessment methods in elderly patients with normal mental status was evaluated in 40 patients older than 70 years scheduled for hip or knee replacement under spinal anaesthesia. Pain evalution was performed using the Visual Analogue Scale and Face Scale, whereas the Lettinen Scale (LS) was used to evaluate the repercussion of pain in daily activities. Presurgical LS showed a pain intensity of 3 an average with a moderate degree of disability, an occasional intake of analgesics and mild sleep disturbances. Joint replacement relieved pain not only in the operated joints, but improvement was also observed in other body areas. However, reduction of pain was not followed by a clear improvement of disability, need of analgesics or sleep disturbances. In conclusion, surgical orthopaedic procedures may alleviate pain in severely afflicted patients. However, they are not definite therapies and very often do not provide full recovery of lost functions, and must be accompanied by a judicious use of analgesics and physical therapies to optimize the results obtained.