State of the art of pain treatment following ambulatory surgery.

Background and objective: The growth of ambulatory surgical procedures is limited by severe postoperative pain. After particularly painful operative procedures, moderate-to-severe pain is estimated to occur in approximately 30% of patients. Inadequate analgesia may delay or prevent discharge, or result in readmission. Severe postoperative pain also causes extreme discomfort and can prevent sleep, thus contributing to postoperative fatigue. Moreover, postoperative pain limits mobility at home and delays the return to normal activities. The development of effective analgesia for postoperative pain is therefore a priority of modern medicine.

Results: The pain experienced during the first days spent at home is related to the magnitude of pain experienced at the hospital. Aggressive analgesic treatment at the hospital is therefore of key importance. This includes pre- and intraoperative administration of analgesics to reduce the pain in the immediate postoperative period, and the use of multimodal, balanced analgesia throughout recovery. Clinical studies have shown that patients who receive both pre- and postoperative analgesia experience greater pain relief than those who receive postoperative analgesia alone. Multimodal analgesia, including the use of anaesthetics, is increasingly important in attempts to avoid the prescription of single strong opioids postoperatively. The use of a non-steroidal anti-inflammatory drug (NSAID) plus an anaesthetic perioperatively has also been shown to be more effective than anaesthetic alone.

Conclusions: Postoperative pain is the most commonly reported complication of ambulatory surgery. Although the number of analgesic techniques seems more limited in outpatient than in inpatient surgery, the combination of analgesic regimens in a multimodal approach may improve postoperative analgesia and functional outcome after ambulatory surgery. The combination of acetaminophen plus tramadol is a useful formulation to prescribe if acetaminophen or NSAIDs alone are ineffective.