Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Karina Charipova,Omar Viswanath,Ivan Urits,Kyle L Gress,Alan D Kaye

doi:10.7759/cureus.10407

Abstract

Ambulatory surgery centers aid the healthcare system by not only providing a cost-effective option for delivery of care but also by helping to reduce overwhelming case volumes at inpatient facilities. While outpatient protocols have been designed for an increasing number of surgical procedures, the inpatient to outpatient transition of surgery remains limited by both procedure type and patient comorbidities. This limitation stems in part from the heavy emphasis on accelerated discharge following outpatient procedures, given that prolonged recovery time is associated with delayed turnover and increased nursing care demands. Since its inception, enhanced recovery after surgery (ERAS) has aimed to primarily reduce the disruption of physiologic homeostasis that occurs secondary to surgery. More recently, the aim of ERAS has evolved to help transition inpatient procedures to outpatient settings and may even be useful in more emergent cases. It should be noted, however, that outpatient surgery even in combination with ERAS is not the best option for all patients, and the use of ERAS protocols should be complemented with predictive assessments of patient risk. Beyond augmenting the efficiency of outpatient surgery, ERAS protocols, when used in eligible patients and especially when combined with regional anesthetic techniques, are effective in delivering opioid-sparing pain management while increasing overall outcomes and patient satisfaction rates.

Highlights

BackgroundAmbulatory surgery centers allow procedures that are traditionally performed on an inpatient basis to be conducted as same-day outpatient surgeries [1]
This limitation stems in part from the heavy emphasis on accelerated discharge following outpatient procedures, given that prolonged recovery time is associated with delayed turnover and increased nursing care demands
That outpatient surgery even in combination with enhanced recovery after surgery (ERAS) is not the best option for all patients, and the use of ERAS protocols should be complemented with predictive assessments of patient risk

Summary

Introduction

Ambulatory surgery centers allow procedures that are traditionally performed on an inpatient basis to be conducted as same-day outpatient surgeries [1]. It has been demonstrated that the trimodal combination of minimally invasive surgery with ERAS and a structured telemedicine program reduced postoperative length of stay, readmission, and emergency department visits In these scenarios, telemedicine augments the ERAS protocol by allowing close monitoring of patients following discharge and enabling prompt intervention for complications [13]. It has been shown that patients who attended a hospital-based preoperative education class prior to undergoing joint replacement surgery were better able to manage their pain after surgery This result suggests that especially in the ambulatory setting, expectations for postoperative activity, mobilization, and timing of discharge should be thoroughly discussed [3]. It is less commonly used in ambulatory settings, systemic lidocaine infusions have been shown to decrease postoperative opioid consumption in patients following laparoscopic colectomy [24]. In cases where such patients are identified, especially those with elevated hemoglobin A1c (HbA1c), exclusion is not necessarily the only option since surgery can be delayed with concomitant referral to specialists such as endocrinologists [7]

Conclusions

Disclosures

Findings

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