الفهرس 
Acknowledgement
Challenges of pain management in the elderly patientsOnly 14 pages are availabe for public view
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Abstract
Epidural analgesia is often considered as a cornerstone in multimodal analgesia regarding major surgeries. However, its role in managing acute postoperative pain in the elderly patients is debatable because of its known potential complications. Furthermore, postoperative pain in the elderly patients is usually under-treated because of complex comorbidities, and they are more prone to adverse events related to pain therapies. All systemic analgesic drugs have their pharmacological limitations and precautions in the elderly people. Recent meta-analyses showed that epidural analgesia provided better postoperative pain control compared to intravenous opioids. Interestingly, Peripheral Nerve Blocks (PNBs) had no superior control of pain over epidural analgesia. In addition, epidural analgesia has shown to positively affect perioperative morbidities and mortalities, reduce opioid-related side effects because of their non-analgesic effects on each organ system. When tailored in a specific multimodal approach, it shortens the intensive care and hospital stays. BEERS Criteria and PROSPECT guidelines are helpful tools for that. In conclusion, if special attention to its complication was paid and clear contraindications were ruled out, epidural analgesia can achieve sufficient postoperative pain management with unsignificant adverse events in this population.