Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia.

PURPOSE OF REVIEW: To review the rational for use of the many regional anesthetic/analgesic techniques and acute pain management modalities in the elderly and cognitively impaired high-risk patients, as increasing numbers of older adults are presenting for surgery.

RECENT FINDINGS: There are numerous studies examining short and long-term consequences of regional anesthesia/analgesia along with identification of the many potential advantages, but those studying the influence and potential benefits in elderly and cognitively impaired patients are only beginning to be developed as issues related to cognitive dysfunction associated with surgery/anesthesia are beginning to be observed.

SUMMARY: Pain management therapy, including regional anesthesia, along with multimodal analgesia may help reduce the risk of negative influences in the elderly patient along with reducing postoperative delirium and cognitive dysfunction. Improvements in analgesic efficacy with regional anesthesia may attenuate pathophysiological surgical responses, reduce the length of hospitalization, and accelerate patient rehabilitation and recovery. Analgesic techniques that provide optimal pain control and low side effect profiles with minimal opioid exposure should always be considered for elderly high-risk and cognitively impaired patients.