Pain management after ambulatory surgery

Purpose of reviewPoor pain management has been a problem after ambulatory surgery. This reviewexamines the current situation and recent advances in the area.Recent findingsDespite significant scientific advances in the management of postoperative pain,surveys continue to show poor pain control in the routine clinical setting ofday-case surgery. Causes are poor implementation of the progress and lack ofadherence to established guidelines with too much reliance on opioids and lack ofcontinuation of analgesic techniques into the postoperative period. The currentliterature with regard to systemic analgesia supports the concept of multimodalanalgesia with an emphasis on the widespread use of appropriate nonopioidsincluding NSAIDs or cyclo-oxygenase-2 inhibitors. The other mainstay of painmanagement after ambulatory surgery should be local anaesthetics, either used singleshot, but with appropriate adjuvants, or by continuous peripheral nerve blocks. The lattertechniques show increasingly promising results with a good safety record and arereviewed extensively.