UMEM Educational Pearls

Category: Orthopedics

Title: Pain Management in Geriatric Orthopaedic Patient

Keywords: geriatrics, orthopaedic, fractur (PubMed Search)

Posted: 11/16/2019 by Michael Bond, MD (Updated: 12/7/2019)
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Pain management is an essential component of care for all patients with orthopedic emergencies, however, one needs to be careful of how pain medication activity can change in a geriatric patient due to:
  1. Decreased hepatic function
  2. Decreased renal function
  3. Multiple comorbidities and polypharmacy that can affect pharmokinetics of pain medications.

Therefore, pain medications must be dosed carefully, which runs the risk of underdosing.  Pain medications can also contribute to delerium, and decreased functional status.

Recommendations:

  1. Start with non-opioid medications in most cases. Consider combination acetaminophen and ibuprofen/naproxen.
  2. Consider regional nerve blocks where applicable due to the decreased risk of systemic side effects and excellent analgesic properties.
  3. If using opioids, start low and reassess and use the lowest dose possible. Remember half-lifes are often prolonged so patient may not need the standard dosing interview.