Analgesia for day-case surgery

Abstract

Recent advances in anaesthetic and surgical techniques, along with escalating healthcare costs, have resulted in an ever-increasing number of surgical procedures being performed on a day-case basis world-wide. The costeffectiveness of day-case surgery is well recognized. Day-case surgery constituted 60‐70% of all surgery performed in North America in the 1990s, 22 but in other parts of the world the numbers are lower. However, as outcome data become available confirming the safety of day-case surgery, it is anticipated that even more procedures will be performed on a day-case basis. Recent surgical advances include the use of endoscopic approaches for procedures such as micro-discectomy, tubal interrupt and carpal tunnel release. Major day-care surgery procedures (e.g. knee and shoulder reconstructions, laparoscopic-assisted vaginal hysterectomies, gastric fundoplications, splenectomies and adrenalectomies) are being performed at many centres. Even pulmonary lobectomy, prostatectomy, carotid endarterectomy and minor craniectomy procedures are being performed on a same-day (or 23 h admission) basis. 94 Major advances in anaesthetic techniques include the use of anaesthetic agents of short duration and increasing use of regional anaesthetic techniques. It is expected that the number, diversity and complexity of operations performed in the outpatient setting will continue to increase. Most day-case surgery procedures are associated with relatively minor surgical trauma, so discharge of these patients frequently depends on recovery from anaesthesia. Top priorities for successful outpatient surgery are the four ‘A’s: alertness, ambulation, analgesia and alimentation. Excessive fatigue, nausea, vomiting or unrelieved pain will delay discharge; these symptoms are the most common reasons for unanticipated hospital admission. Since the proportion of surgery done on an outpatient basis is increasing, and since early discharge and patient satisfaction are important goals, pain management is receiving greater attention.