Abstract: Postoperative delirium is a common complication following surgery in elderly patients, characterized by fluctuating disturbances in mental status that significantly affect recovery and quality of life. Identifying and effectively addressing the risk factors associated with postoperative delirium can enhance the prognosis for these patients. Pain is recognized as an independent risk factor for the development of postoperative delirium. In recent years, effective perioperative pain management has garnered considerable attention as a modifiable factor in preventing postoperative delirium (POD), with adequate analgesia shown to reduce its incidence. This review examines studies on perioperative pain management aimed at decreasing the occurrence of delirium, summarizes the potential pathophysiological mechanisms underlying pain-induced postoperative delirium, and explores the roles of various pain management strategies in its prevention, aiming to provide new insights for reducing the incidence of postoperative delirium.