Pain as a Factor Complicating Recovery and Discharge After Ambulatory Surgery

Pavlin, D. Janet; Chen, C.; Penaloza, D. A.; Polissar, Nayak L.; Buckley, F. Peter

doi:10.1097/00000539-200209000-00025

Cited by 170 publications

(115 citation statements)

References 14 publications

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“…Overall, it will benefit patient satisfaction as well as benefit the entire health care system now that proper pain assessment and management has become a priority. 23,32,53,70,72 Conclusion Pain management in the perioperative period is very crucial in managing morbidities in patients. Orthopedic procedures have been reported to be the most painful postoperatively, but patient pain continues to be poorly managed.…”

Section: Discussionmentioning

confidence: 99%

Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

Desai¹,

Cheung²

2012

Journal of Shoulder and Elbow Surgery

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Section: Discussionmentioning

confidence: 99%

Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

Desai¹,

Cheung²

2012

Journal of Shoulder and Elbow Surgery

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“…However, many patients undergoing ambulatory surgery under general anesthesia experience unacceptable levels of nausea and vomiting (N/V) after surgery 6,7). Although ambulatory patients are less likely to experience postoperative N/V than inpatients, this could be partly explained by an under-recognition of postdischarge N/V because ambulatory patients are not under direct medical supervision after their discharge 8).…”

mentioning

confidence: 99%

“…However, incidences of those events are known to be influenced by the type of surgical procedure,6,14) as the surgical location, such as abdominal surgery or a head and neck (near the ear) surgery can affect N/V levels. Also patients undergoing lower extremity surgeries that require admission may get a better treatment of their N/V.…”

mentioning

confidence: 99%

Factors Associated with Postoperative Nausea and Vomiting in Patients Undergoing an Ambulatory Hand Surgery

et al. 2014

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BackgroundPatients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels.MethodsWe prospectively evaluated 200 consecutive patients who underwent ambulatory hand surgeries under general anesthesia to assess their postoperative N/V visual analogue scale (VAS) levels during the first 24 hours after surgery and their satisfaction with an ambulatory surgery setting. Potential predictors of postoperative N/V were; age, sex, body mass index, smoking behavior, a history of postoperative N/V after previous anesthesia or motion sickness, preoperative anxiety level and the duration time of anesthesia. We conducted multivariate analyses to identify factors associated with postoperative N/V levels. We also conducted multivariate logistic regression analyses to determine whether the N/V levels are associated with the patients' satisfaction with this setting. Here, potential predictors for satisfaction were sex, age, postoperative pain and N/V.ResultsPostoperative N/V were associated with a non-smoking history, a history of motion sickness and a high level of preoperative anxiety. Twenty-two patients (11%) were dissatisfied with the ambulatory setting and this dissatisfaction was independently associated with moderate (VAS 4-7) and high (VAS 8-10) levels of postoperative N/V and with a high level (VAS 8-10) of postoperative pain.ConclusionsAlthough most of the patients were satisfied with the ambulatory surgery setting, moderate to high levels of N/V were associated with dissatisfaction of patients with this setting, suggesting a need for better identifying and managing those patients at risk. The information regarding risk factors for N/V could help in preoperative patient consultation regarding an ambulatory hand surgery under general anesthesia.

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“…[31] The approach to post-operative pain should be a multimodal too, where a combination of several techniques may be used. Ideally, there should be no pain or a minimally tolerable pain after surgery.…”

Section: Role Of the Anesthesiologistmentioning

confidence: 99%

Fast-track surgery: Toward comprehensive peri-operative care

Nanavati

Prabhakar

2014

Anesth Essays Res

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Fast-track surgery is a multimodal approach to patient care using a combination of several evidence-based peri-operative interventions to expedite recovery after surgery. It is an extension of the critical pathway that integrates modalities in surgery, anesthesia, and nutrition, enforces early mobilization and feeding, and emphasizes reduction of the surgical stress response. It entails a great partnership between a surgeon and an anesthesiologist with several other specialists to form a multi-disciplinary team, which may then engage in patient care. The practice of fast-track surgery has yielded excellent results and there has been a significant reduction in hospital stay without a rise in complications or re-admissions. The effective implementation begins with the formulation of a protocol, carrying out each intervention and gathering outcome data. The care of a patient is divided into three phases: Before, during, and after surgery. Each stage needs active participation of few or all the members of the multi-disciplinary team. Other than surgical technique, anesthetic drugs, and techniques form the cornerstone in the ability of the surgeon to carry out a fast-track surgery safely. It is also the role of this team to keep abreast with the latest development in fast-track methodology and make appropriate changes to policy. In the Indian healthcare system, there is a huge benefit that may be achieved by the successful implementation of a fast-track surgery program at an institutional level. The lack of awareness regarding this concept, fear and apprehension regarding its implementation are the main barriers that need to be overcome.

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Pain as a Factor Complicating Recovery and Discharge After Ambulatory Surgery

Cited by 170 publications

References 14 publications

Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

Factors Associated with Postoperative Nausea and Vomiting in Patients Undergoing an Ambulatory Hand Surgery

Fast-track surgery: Toward comprehensive peri-operative care

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