Pain management after ambulatory surgery.

PURPOSE OF REVIEW: Poor pain management has been a problem after ambulatory surgery. This review examines the current situation and recent advances in the area.

RECENT FINDINGS: Despite significant scientific advances in the management of postoperative pain, surveys continue to show poor pain control in the routine clinical setting of day-case surgery. Causes are poor implementation of the progress and lack of adherence to established guidelines with too much reliance on opioids and lack of continuation of analgesic techniques into the postoperative period. The current literature with regard to systemic analgesia supports the concept of multimodal analgesia with an emphasis on the widespread use of appropriate nonopioids including NSAIDs or cyclo-oxygenase-2 inhibitors. The other mainstay of pain management after ambulatory surgery should be local anaesthetics, either used single shot, but with appropriate adjuvants, or by continuous peripheral nerve blocks. The latter techniques show increasingly promising results with a good safety record and are reviewed extensively.

SUMMARY: Multimodal analgesia and local anaesthetic techniques are the avenues to improve the still disappointing quality of analgesia after ambulatory surgery.