INTERVENTIONAL MODALITIES IN ACUTE PAIN MANAGEMENT IN OLDER ADULTS
In addition to the surgery-related pain, there are a number of indications for use of interventional pain management techniques in older adults in acute care settings. Neuraxial analgesia (see Table 12.1) is a useful modality for pain related to trauma such as extremity fractures, pelvic, and/or rib fractures, as well as intractable cancer pain. Single shot techniques are more useful in ambulatory settings, whereas indwelling catheters are commonly used in hospitalized patients with few exceptions.27
Peripheral Nerve Blocks in Acute Pain Management
A number of peripheral nerve blocks can be performed in the management of acute postoperative pain, acute trauma pain, or cancer-related pain in older adults. The goal is to optimize pain relief and minimize the need for systemic analgesics, which in turn would minimize the occurrence of systemic side effects for vulnerable populations. The exact type of nerve block would depend on the area of pain or desired surgery as listed in Table 12.2. These blocks can be single shot blocks or a perineural catheter can be left in place to help with pain relief and physical therapy in the postoperative period. Local anesthetic medications are commonly used for acute situations. For cancer pain management, neurolytic agents like alcohol or phenol can be used. In most institutions, ultrasound- guided blocks have become the norm, although these blocks can be performed using anatomical landmarks or electrical nerve stimulation. The type of medication used depends on desired onset and duration of action. Bupivacaine or ropivacaine is used commonly as these agents have a longer duration of effect, with analgesia lasting for about 12-18 hours after a single dose. The total dose of local anesthetic injected must be taken into account to prevent systemic toxicity. The American Society of Anesthesiologists recommends patient monitoring with pulse oximetry, electrocardiography, and blood pressure measurements, while performing these procedures.