Anesthetic and Analgesic Management Using Intravenous Multimodal Analgesia in an Elderly Diabetic Patient Undergoing Hartmann’s Procedure
Abstract
Elderly diabetic patients undergoing emergency colorectal surgery present significant anesthetic and analgesic challenges. Thoracic epidural analgesia is considered the gold standard for postoperative pain control; however, refusal or contraindications may necessitate alternative techniques. This case describes the use of a WHO pain ladder–guided intravenous multimodal analgesic strategy in a 71-year-old patient undergoing Hartmann’s procedure. Stepwise escalation of non-opioid, weak opioid, and strong opioid analgesics allowed effective intraoperative pain control, hemodynamic stability, and minimized postoperative opioid requirements.
[1] American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331-46.
[2] Schofield P, Abdulla A, Adams N, Bond M, Farquhar M, Harrop D, et al. Evidence-based clinical practice guidelines on the management of pain in older people: A summary report. Br J Pain. 2022;16(1):6-13.
[3] Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-57.
[4] Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin Anaesthesiol. 2019;33(3):259-67.
[5] Ibrahim A. Paracetamol (Acetaminophen) [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2026 May 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482369/
[6] Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004;43(13):879-923.
[7] Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg. 2017;152(3):292-8.
[2] Schofield P, Abdulla A, Adams N, Bond M, Farquhar M, Harrop D, et al. Evidence-based clinical practice guidelines on the management of pain in older people: A summary report. Br J Pain. 2022;16(1):6-13.
[3] Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-57.
[4] Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin Anaesthesiol. 2019;33(3):259-67.
[5] Ibrahim A. Paracetamol (Acetaminophen) [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2026 May 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482369/
[6] Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004;43(13):879-923.
[7] Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg. 2017;152(3):292-8.
| Files | ||
| Issue | Article in Press |
|
| Section | Case Report(s) | |
| Keywords | ||
| WHO pain ladder multimodal analgesia Hartmann’s procedure diabetes mellitus elderly intraoperative analgesia | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Borikar S, Arunachalam S. Anesthetic and Analgesic Management Using Intravenous Multimodal Analgesia in an Elderly Diabetic Patient Undergoing Hartmann’s Procedure. Arch Anesth & Crit Care. 2026;.
