Perioperative Pain Management Issues Unique to Older Adults Undergoing Surgery

Abstract

Introduction: The older population is growing and with this growth, there is a parallel rise in the operations performed on this vulnerable group. The perioperative pain management strategy for older adults is unique and requires a team-based approach for provision of high-quality surgical care. Methods: Literature search was performed using PubMed in addition to review of relevant protocols and guidelines from geriatric, surgical, and anesthesia societies. Systematic reviews and meta-analyses, randomized trials, observational studies, and society guidelines were summarized in this review. Management: The optimal approach to pain management for older adults undergoing surgery involves addressing all phases of perioperative care. Preoperative assessment of patients' cognitive function and presence of chronic pain may impact the pain management plan. Consideration should be also be given to intraoperative strategies to improve pain control and minimize both the dose and side effects from opioids (eg, regional anesthetic techniques). A multimodal postoperative pain management strategy minimizing opioids is crucial to providing adequate pain control while minimizing elderly-specific complications such as postoperative delirium and functional decline. Finally, pain management does not stop after the older adult patient leaves the hospital. Both discharge planning and postoperative clinic follow-up provide important opportunities for collaboration and intervention. Conclusions: An opioid-sparing pain management strategy for older adults can be accomplished with a comprehensive and collaborative interdisciplinary strategy addressing all phases of perioperative care.

Pain With Differing Insufflation Pressures During Robotic Sacrocolpopexy

“…Use of opioids for pain management in the elderly is associated with significant risk of adverse events, including sedation, falls, respiratory depression, dizziness, impaired motor coordination, and cognitive dysfunction. 13 The small absolute difference of 3 mm Hg between insufflation groups did not compromise surgical performance or increase adverse events. The experimental pressure was selected on the basis of the senior author's clinical opinion and operative experience.…”

“…Use of opioids for pain management in the elderly is associated with significant risk of adverse events, including sedation, falls, respiratory depression, dizziness, impaired motor coordination, and cognitive dysfunction. 13…”

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

“…International guidelines recommend opioids as first line for the management of severe pain in chronic limb-threatening ischemia [ 23 ]. Further, pain can be a treatable cause of delirium and hence there may be an appropriate role for the prescribing of opioids and opioid-sparing analgesia in this population [ 24 , 25 ].…”

Efficacy of pericapsular nerve group (PENG) block on perioperative pain management in elderly patients undergoing hip surgical procedures: a protocol for a systematic review with meta-analysis and trial sequential analysis

“…[14][15][16][17][18][19] In elderly patients, the risk of perioperative adverse events is higher due to polypharmacy and multimorbidity. [20][21][22] In contrast, adequate pain management has been shown to facilitate postoperative mobilisation, improve mobility and promote better functional recovery. [23][24][25][26] Early mobilisation has been associated with reducing postoperative complications, including pneumonia, venous thromboembolism, pressure ulcers and delirium.…”