Management of perioperative pain in older adults can be challenging. Multimorbidity, functional decline or diminished physiological reserves, the corresponding polypharmacy, age-related pharmacodynamic and pharmacokinetic changes need to be considered. #Pain assessment can be complicated by cognitive impairment and communication barriers. Older adults are at high risk of adverse consequences from surgery and undertreated pain as well as pharmacological overtreatment. Effective pain control in the perioperative period needs to be balanced against potential pharmacological harm. The aim of the orthogeriatric working group is to provide a practical guide for pain management in the perioperative orthogeriatric setting. It is supposed to be safe, effective and patient-centered. The set of expert recommendations is based on a current literature review, on the fit for the aged (FORTA )list expert consensus validation 2021 (4th edition), the PRISCUS list 2.0 of potentially inappropriate medications for older patients as well as on expert opinion and best clinical practice. Adequate analgesia is best achieved by applying multimodal analgesia. Various groups of analgesics are combined with interprofessional nonpharmacological treatment approaches. This article focuses on the pharmacological management of perioperative pain. Adequate analgesia can improve the overall outcome of orthogeriatric patients.
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