Perioperative Pain Management in the Elderly Surgical Patient

Background: There has been an increase in the number of elderly patients undergoing surgery. This particular patient population have unique age related comorbidities that lead to an increase in postoperative complications involving the neurological, pulmonary, cardiac and endocrine systems. Despite advances in anesthesia and analgesia, mono-therapy with opioids continues to be the mainstay for treatment of post-op pain, which often times leads to inadequate pain control, or gastrointestinal and respiratory compromise. Regional anesthesia and multimodal analgesic regimens are promising alternatives to reduce high doses and dependence of opioids and the adverse effects that accompany. Methods: The authors searched the following databases for relevant published trials: the Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions: Incorporating perioperative regional techniques and multimodal drug therapy can be a very effective approach to perioperative pain management in the elderly and cognitively impaired. Regional anesthesia can often reduce postoperative neurological, pulmonary, cardiac and endocrine complications. It has not been completely proven to improve long-term morbidity, but does improve immediate post-operative pain control. Multimodal drug therapy utilizes a variety of analgesic medications (non-opioids) in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.