title: The comparison of two analgesic regimes after ambulatory surgery: an observational study.
abstract: BACKGROUND
  Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of moderate-to-severe pain, side effects, and the use of escape medication of two different analgesic regimes after ambulatory surgery.
  
  
  METHODS
  In this observational study, at the day care center of the Radboud University Nijmegen Medical Centre, patients were followed during the period from April 2010 till October 2011. At the day care center, a multimodal analgesic regime with paracetamol (1000), diclofenac (75), and tramadol (50) and an analgesic regime with a combination tablet tramadol/paracetamol (37.5/325) and diclofenac (75) were prescribed in different periods for ambulatory surgery. Prior to surgery and during the first 3 days after surgery, patients were asked to complete five questionnaires. In these questionnaires, they were asked about pain (NRS) at rest and when moving, experienced side effects, and the analgesic medication taken.
  
  
  RESULTS
  A total of 375 patients participated in the study, of which 99 in the tramadol group and 138 in the combination tablet tramadol/paracetamol group. The percentage of patients with moderate-to-severe postoperative pain was 25% to 40%. In both the groups, an equal percentage of patients experienced moderate-to-severe postoperative pain. Both analgesic regimes have a comparable analgesic effectiveness with each with its own specific advantages and disadvantages. On the first day after surgery, patients with the tramadol/paracetamol regime experienced more side effects (drowsiness and nausea) were less therapy compliant, but needed a smaller amount of escape medication than the patients from the tramadol group.
authors.affiliation: Department Anesthesiology Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Froukje
authors.initials: F
authors.lastname: van der Worp
authors.forename: Jeroen T
authors.initials: JT
authors.lastname: Stapel
authors.forename: Sandra
authors.initials: S
authors.lastname: Lako
authors.forename: Jan
authors.initials: J
authors.lastname: Hendriks
authors.forename: Kris C P
authors.initials: KC
authors.lastname: Vissers
authors.forename: Monique A H
authors.initials: MA
authors.lastname: Steegers
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011795:Surveys and Questionnaires; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D004008:Diclofenac; D000082:Acetaminophen; D014147:Tramadol
keywords: ambulatory; multimodal analgesia; operative; pain; postoperative; surgical procedures; tramadol