Systemic pharmacologic postoperative pain management in the geriatric orthopaedic patient

Although older adults have surgical procedures more frequently than any other group, they also experience the worst postoperative pain management. Among patients with orthopaedic disorders, this undertreatment of pain impacts postsurgical functional recovery and clinical outcomes. Recently adopted evidence-based pain management guidelines have improved care, but there still is significant room for improvement. We review standards for pain assessment in cognitively intact and impaired older adults, provide detailed guidelines for the pharmacologic treatment of postoperative pain in the orthopaedic geriatric patient, and review the step-wise approach to effective side-effect management in this population.