Pain control in older adults undergoing video-assisted thorascopic surgery

The older adult patient population is growing, composing a significant portion of those undergoing video-assisted thorascopic surgery (VATS). The physiological changes experienced by this population impact every organ system and require advanced understanding and prioritization as they impact pain presentation and the pharmacokinetics of pain medicines. Optimizing preoperative functioning prior to surgical intervention may promote improved pain control in older adults. The approach to pain control perioperatively should be focused on a multimodal approach considering the patient's medical comorbidities. Focus should be placed on cognitive deficits which may act as barriers to recognizing and treating postoperative pain in older adult patients. Understanding the etiology of pain and the unique pain presentation in older adults will guide the assessment of and multimodal pain approach to pain control following VATS. A multimodal approach to postoperative pain control should include analgesics with diverse mechanisms of action such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant medications. Additionally, pain regimens should consider utilizing regional anesthesia and non-pharmacological pain control approaches to decrease the use of opioids. Throughout the planning, treatment, and monitoring of older adults with postoperative pain following VATS, patients' physiology, and comorbidities must be considered to guide appropriate pain control and avoid unwanted complications.