Pain management in frail patients according to ERAS philosophy, key concepts and pitfalls

Given the growing mean age of population, a substantial percentage of patients undergoing surgical procedures can be classified as elderly or as frail, because oncological, malnourished, anemic, depressed or with chronic organ failure. Identification of frailty in the preoperative assessment is essential for implementing the application of ERAS protocols, whose main principles are potentially tailored for frail patients. Preoperative optimization and minimal invasiveness are mandatory to improve baseline resilience of these subjects. In particular, being pain a strong determinant of frailty, adequate multimodal postoperative analgesia is strongly recommended. Despite the limited number of studies available, current evidence suggests that application of ERAS protocols to frail patients may reduce the rates of postoperative complications.