Postoperative pain in older adults is probably underappreciated, in the sense that many clinicians are hesitant to treat with opioids due to the risk of respiratory depression. However, what we’ve learned is that the inadequate use of opioids actually can lead to greater pain postoperatively in older adults. It can lead to delirium. It can lead to confusion. It can lead to less mobilization of that particular patient following surgery which, in turn, can lead to greater hospital stays, greater utilization of resources. It’s important to realize that opioids really are the gold standard for older adults as well, postoperatively, and can be used and should be used in the form of an intravenous patient-controlled device.
Multimodal therapies also can and should be utilized if possible in older adults. Therapies such as spinal anesthetics, epidural anesthetics during surgery, regional anesthetic blocks during surgery that can be used to help reduce pain during surgery but also, importantly, after surgery. If you use those techniques intraoperatively, it not only can provide better pain relief postoperatively, but can pretty much stave off having to increase doses of opioids and encountering complications associated with high-dose opioids or even complications associated with delirium and confusion from inadequate pain control.