Perioperative Pain Management Issues Unique to Older Adults Undergoing Surgery: A Narrative Review

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 a pain management strategy for older adults undergoing surgery involves addressing all phases of perioperative care. For example, preoperative assessment of a patient's cognitive function and presence of chronic pain may impact the pain management plan. Consideration should be also given to intraoperative strategies to improve pain control and minimize both the dose and side effects from opioids (e.g. regional anesthetic techniques). Postoperative pain control (e.g. under or over treatment of pain) may impact the development of 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 post-operative 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.

FIGURE 1.

Pain management strategy overview for phase of perioperative care.

FIGURE 2.

Postoperative multimodal pain strategy for successful pain relief in the older adult. GABA indicates gamma-aminobutyric acid; i.v., intravenous; NSAIDs, nonsteroidal anti-inflammatory drugs; PCA, patient-controlled analgesia.

FIGURE 3.

Medications to be avoided in older adult based on 2019 Beers Criteria. GABA indicates gamma-aminobutyric acid.