Role of non-opioid analgesics in ambulatory anesthesia

Abstract

T he optimal anesthetic technique in the ambulatory setting would provide for excellent operating conditions, a rapid recovery, no postoperative side effects, and a high degree of patient satisfaction. In addition to improving the quality of care and decreasing the costs of the anesthetic services, the ideal anesthetic technique would also improve operating room (OR) efficiency and provide for an early discharge home. Local infiltration anesthesia with sedation (so-called monitored anesthesia care [MAC]), spinal anesthesia, and general anesthesia are all commonly used for ambulatory surgery. However, opinions differ as to the best anesthetic technique for these surgical procedures.l-14 In the current cost-conscious environment, it is important to examine the impact of anesthetic techniques on the recovery process after ambulatory surgery because prolonged recovery times and perioperative complications increase the cost of patient care. In addition, the level of patient satisfaction with their care is improved when the anesthetic technique chosen for the procedure is associated with a low incidence of postoperative side effects. For example, routine use of prophylactic antiemetic drugs during general anesthesia has been found to increase patient satisfaction in at risk outpatient surgical populations. 15 The use of effective peripheral local anesthetic block or infiltration/instillation techniques to supplement both MAC and general anesthesia is the key to providing successful non-opioid anesthesia in the ambulatory setting (Table 1). For example, the use of a simple ilioinguinal-hypogastric nerve block decreases postoperative pain after inguinal hernia repair procedures irrespective of the anesthetic technique. 3,16,17 The time required to achieve a state of homereadiness is influenced by a wide variety of surgical and anesthetic factors. 18'19 However, the major contributors to delays in discharge after ambulatory surgery are nausea, vomiting, dizziness, pain, and prolonged sympathetic and/or motor blockade. Although the incidence of postoperative nausea and vomiting can be decreased by the use of proTable 1. Commonly Used Techniques for Administering Local Anesthesia for Ambulatory Surgery