Analgesics in day case surgery

Jan Jakobsson

in Anaesthesia for Day Case Surgery

Published on behalf of Oxford University Press

Published in print May 2012 | ISBN: 9780199652969
Published online October 2012 | e-ISBN: 9780191742972 | DOI:

Series: Oxford Anaesthesia Library

Analgesics in day case surgery

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  • Anaesthetics
  • Clinical Pharmacology and Therapeutics
  • Peri-operative Care


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• The day case patient is to leave the hospital within hours following surgery; thus special emphasis must be placed on providing adequate pain management throughout the perioperative course as well as following discharge. • Information and active coaching of the patient through the entire perioperative period is of great importance; patient satisfaction is important and efforts should be focused on obtaining adequate pain relief with minimum side effects. • A multi-modal pain management strategy has become the gold standard. Pain management should already have been addressed in preoperative preparation and information. Provide the patient with a prescription in order to have adequate medication at home after return from the procedure or provide take-home medications and information about their use. • The use of local anaesthesia intraoperatively, fast-acting anaesthesia prior to incision and long-acting anaesthesia at skin closure, should be advocated strongly wherever possible; this pre-incision and at-wound-closure technique should also be used in patients who undergo surgery under general anaesthesia, as it helps to reduce the noxious influx and thus reduce the pain intra as well as postoperatively. • Intraoperative opioid analgesics should be used where needed but at the lowest effective dose. • Postoperative pain management is based on a long-acting local anaesthetic in the wound at closure, and oral pain medications (NSAID or “coxib” for 3–5–7 days and additional paracetamol 1 g up to four times daily) and further availability of an oral opioid as a rescue pain medication when needed. • For more painful procedures, a long-acting slow-release oral opioid should be added and a fast-acting oral opioid provided as rescue pain therapy in order to handle incidences of “breakthrough” pain. • Wound catheter or perineural catheters with continuous infusion of local anaesthesia, patient-controlled regional analgesia (PCRA), should be considered in procedures where profound postoperative pain can be expected. • Pain management should cover at least up to a week. Patients should be informed to reduce intake as pain ceases.

Chapter.  6261 words.  Illustrated.

Subjects: Anaesthetics ; Clinical Pharmacology and Therapeutics ; Peri-operative Care

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