title: Perioperative Pain Control in the Ambulatory Setting.
abstract: Across the USA and various parts of the world, ambulatory surgery centers have transitioned to accepting patients with advanced ASA statuses, leading to a larger volume and higher complexity of surgeries performed, while still urging for same-day patient discharges. Inadequate postoperative pain management and opioid analgesia side effects, such as sedation, respiratory depression, and postoperative nausea and vomiting, are the most common complications and most common reasons for readmission after ambulatory surgery. The trend to limiting these complications and achieve a more rapid patient discharge currently emphasizes a multifactorial, balanced analgesia strategy. This article reviews the multimodal approach by detailing the important aspects of specific regional nerve blocks, nerve blockade with catheter techniques, acetaminophen, non-selective NSAIDs, Cox-2 inhibitors, membrane stabilizers, and corticosteroids. Pain management in the ambulatory surgery patient will thus be optimized with a thorough preoperative evaluation, recognizing intraoperative events, and implementing multiple analgesic modalities.
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA. maunakr@gmail.com.
authors.forename: Maunak V
authors.initials: MV
authors.lastname: Rana
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA. Mr.ravi.desai@gmail.com.
authors.forename: Ravi
authors.initials: R
authors.lastname: Desai
authors.affiliation: Department of Anesthesiology, LSUHSC School of Medicine, 1542 Tulane Avenue, Suite 659, New Orleans, LA, 70112, USA. lngo@lsuhsc.edu.
authors.forename: Lien
authors.initials: L
authors.lastname: Tran
authors.affiliation: Department of Anesthesiology, LSUHSC School of Medicine, 1542 Tulane Avenue, Suite 659, New Orleans, LA, 70112, USA. ddav36@lsuhsc.edu.
authors.forename: D'Andra
authors.initials: D
authors.lastname: Davis
mesh_terms: D000556:Ambulatory Surgical Procedures; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D009407:Nerve Block / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Ambulatory surgery; Intravenous acetaminophen; Multimodal analgesia; Nerve block catheter; Neuraxial blockade; Outpatient; Pain management; Paravertebral block; Pregabalin; Regional anesthesia; TAP block; Ultrasound block