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Postoperative pain management following ambulatory anesthesia: challenges and solutions
Authors Schug S, Chandrasena C
Received 17 October 2014
Accepted for publication 22 October 2014
Published 13 January 2015 Volume 2015:2 Pages 11—20
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Gildasio S De Oliveira Jr.
Stephan A Schug,1,2 Chandani Chandrasena2
1School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia; 2Department of Anesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia
Abstract: Worldwide, there is an increasing trend toward performing more and more complex surgery in an ambulatory setting, partially driven by economic considerations. Provision of appropriate pain relief is still often inadequate in this setting; poor pain control and adverse effects of opioids provided for pain control are common reasons for readmission, with human and economic consequences. Therefore, improved analgesia after ambulatory surgery is an important goal; appropriate strategies include identification of at-risk patients, provision of multimodal analgesia, and early use of rescue strategies. Multimodal analgesia is based on the combined use of multiple medications or techniques for pain control, which have different mechanisms of action or act on different sites at the pain pathways. Thereby, such an approach improves analgesia, reduces opioid requirements, and reduces adverse effects of opioids. Important components of multimodal analgesia are nonopioids (acetaminophen and anti-inflammatory drugs), corticosteroids, and alpha-2-delta modulators (gabapentin, pregabalin), but most importantly the use of local and regional anesthesia techniques. Here, the use of adjuvants is one way to increase the duration of pain relief, but, increasingly, continuous peripheral nerve blocks via catheters are used in ambulatory patients, too. Finally, the planning of discharge medications needs a balancing act between the requirements for provision of good analgesia and the risk of opioids going out into the community.
Keywords: ambulatory surgery, short-stay surgery, multimodal analgesia, nonopioids, local anesthetics, regional anesthesia
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