SciELO - Scientific Electronic Library Online

 
vol.14 número1Papel do farmacêutico no seguimento farmacoterapêutico para o controle da dor de origem oncológicaAvaliação da qualidade de vida em idosos submetidos à artroplastia de quadril: relato de casos índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Journal

Artigo

Indicadores

Links relacionados

Compartilhar


Revista Dor

versão impressa ISSN 1806-0013

Rev. dor vol.14 no.1 São Paulo jan./mar. 2013

http://dx.doi.org/10.1590/S1806-00132013000100015 

REVIEW ARTICLE

 

Pain management after outpatient surgical procedure*

 

 

Rodney Junqueira PereiraI; Masachi MunechikaII; Rioko Kimiko SakataIII

IResident in Anesthesiology, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP). São Paulo, SP, Brazil
IIAssistant Professor, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP). São Paulo, SP, Brazil
IIIAssociate Professor and Coordinator of the Pain sector, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP). São Paulo, SP, Brazil

Correspondence to

 

 


ABSTRACT

BACKGROUND AND OBJECTIVES: Adequate postoperative pain control is critical for any outpatient surgical procedure. This study aimed at evaluating analgesics and techniques used to manage pain of this type of procedure.
CONTENTS: Factors associated to postoperative pain intensity, parameters to be considered for outpatient surgeries, major management techniques for pain relief and the uniqueness of some surgical procedures were addressed.
CONCLUSION: Effective pain control is critical for outpatient surgeries and is aimed not only at comfort but also at decreasing complications and early rehabilitation of patients. Multimodal analgesia is beneficial, but management has to be tailored since there are several drugs and techniques for pain relief.

Keywords: Analgesia, Analgesics, Outpatient surgery, Postoperative pain, Treatment.


 

 

INTRODUCTION

Postoperative pain (POP) should be rapidly and effectively managed. Its inadequate management after outpatient surgery is directly reflected on patients' recovery. This inadequacy may be both on the effective pain control and on the use of excessive doses of anti-inflammatory drugs and opioids1.

Many patients have severe pain after hospital discharge. In a questionnaire sent to 92 Sweden hospitals, the most frequent complaint was pain2. With the increasing number of outpatient procedures, there has also been an increase in the number of patients needing aggressive multimodal analgesia regimens for effective POP control3.

Effective pain control is critical for outpatient procedures success. To be efficient and safe, postoperative analgesia requires preoperative planning, identification of risk factors and level of surgical manipulation, evaluation of pain intensity and postoperative sedation, understanding the pharmacology of analgesic agents, their indications and control of adverse effects observed during treatment.

Pubmed database was searched using as keywords the following: ambulatory surgery, multimodal analgesia, nonopioid analgesics, nonpharmacologic analgesic therapies, opioid analgesics, postoperative (acute) pain management. All controlled clinical trials and systematic reviews focusing on pharmacological and non-pharmacological therapy to control pain of patients submitted to outpatient surgeries were selected.

This study aimed at evaluating analgesics and techniques used to manage pain in this type of procedure.

 

PAIN INTENSITY-RELATED FACTORS

POP intensity depends on several factors: surgery site and length, type of surgical incision, surgery size and surgical trauma intensity, previous surgeries with adhesions on the site to be explored, physical status, preoperative preparation and psychological acceptance by patients. In addition, it also depends on the type of anesthesia, on the quality of postoperative analgesia and on early movement of patients submitted to outpatient procedures. From all factors, surgery site is the most related to pain intensity.

 

OUTPATIENT SURGICAL PROCEDURES

Outpatient surgery may be performed in a hospital or in a simpler and more autonomous facility, which may belong or not to a hospital.

Outpatient procedures are adequate when postoperative treatments may be easily made at home with low surgical complication rates, and which do not require intensive treatment or a nursing team treatment.

There are differences among centers as to the indication of outpatient procedures. Procedures such as cholecystectomy, vaginal hysterectomy, reduction mammoplasty, open arthrotomy with ligament repair and thyroidectomy are performed in some centers in outpatient regimen; while in other services these procedures are limited to hospitalized patients. Surgery length is not a criterion to contraindicate outpatient procedures because there is a weak relationship between length of anesthesia and recovery4. Longer procedures are in general performed early in the day. The need for blood products transfusion is also not a contraindication for outpatient procedures5.

Some patients submitted to liposuction receive autologous blood and are discharged, if there are no complications. Advanced age alone is also not a reason preventing outpatient surgeries. Age, however, affects drug pharmacokinetics, and even for those short-lasting such as midazolam and propofol, clearance is decreased for elderly individuals6. Another major criterion is patients' physical status according to ASA classification. Outpatient surgeries are no longer limited to patients physical status I or II. It is adequate for patients physical status III or IV if systemic diseases are clinically stable6.

Patients submitted to outpatient procedures should have escorts to take them home and remain with them to assist them when needed. Before surgery, patients should be informed about the procedure, place where it will be performed, laboratory exams to be done and dietary restrictions. Patients should be aware that they will go home in the same day of the surgery and they or someone in charge should be able to assure that all guidelines will be adhered to. Once at home, patients should be able to tolerate postoperative pain, supposing that adequate therapy has been provided for its relief. Most patients are happy with early discharge, although some elect to remain for a longer period in the hospital7.

In a study, authors have delivered a questionnaire to hospitals, which became the basis for a follow up during the first two days after surgery. Several hospitals have used this patients' evaluation within 24 hours to standardize the pain score which would be the criterion for hospital discharge2.

 

TREATMENTS

Systemic analgesia

Non-steroid anti-inflammatory drugs, paracetamol and dipirone

Most common drugs for effective POP control are non-steroid anti-inflammatory drugs (NSAIDs) and opioids. Several drugs of these classes have been studied to compare their efficacy.

NSAIDs are used alone or in association with opioids or regional analgesia for POP control. They do not induce respiratory depression and decrease the necessary opioid dose, thus decreasing the incidence of respiratory depression, as well as other adverse effects. They are recommended for postoperative multimodal analgesia and are administered by different routes, depending on the possibility. These drugs are indicated for mild to moderate pain. For severe pain they are administered in association with other analgesics or analgesic techniques. Selective COX-2 inhibitors are also effective for outpatient procedures with postoperative pain control. They promote pain relief in a wide variety of outpatient procedures8. There is a significant benefit for patients' clinical conditions at discharge, both in returning to daily activities and in controlling short-term POP with the use of classic NSAIDs or COX-2 inhibitors9,10.

Dipirone is highly effective, has low cost and broad safety margin. It is commonly used as primary or coadjuvant agent to treat acute postoperative pain11,12. Its action mechanism remains controversial. There is the hypothesis of peripheral action inhibiting the activation of adenylcyclase by hyperalgesic substances and blocking calcium entrance in the nociceptor. Other possibility is the activation of ATP-sensitive potassium channels13,14. It may act on cyclooxygenases activity.

There are evidences of a COX-2 variant, or a new COX enzyme, which could be inhibited by paracetamol15. Studies suggest that paracetamol inhibits central COX-216. Central analgesic effect of paracetamol may be due to the activation of descending serotoninergic pathways, but its primary action might be the inhibition of prostaglandin synthesis17. However, a different hypothesis suggests antagonist effect of N-Methyl-Aspartate receptors or nitric oxide-related mechanism16.

Tramadol and opioids

Tramadol promotes the inhibition of norepinephrine and serotonin reuptake in medullary synapse. (+) tramadol and the metabolite (+)-O-desmethyltramadol (M1) are µ receptor agonists. (+) tramadol inhibits serotonin reuptake while (-) tramadol inhibits norepinephrine reuptake with inhibitory effect on medullary transmission. Additional and synergistic action of enantiomers improves analgesic efficacy and tolerability18. The metabolite has high affinity to receptors and the analgesic effect depends on both tramadol and the metabolite19.

Opioids are potent analgesics indicated for moderate to severe POP. They promote analgesic effect for most procedures with extensive trauma, have good action for severe pain, do not have ceiling dose for the analgesic effect and may be antagonized. They may be administered by oral, venous, subcutaneous, sublingual, spinal, intra-articular and regional venous routes. Taking into consideration the outpatient procedure proposal, best routes for drug administration are oral, spinal, regional venous and intra-articular, in addition to local infiltration and for use in nervous and plexus blocks.

Most opioids are agonists with predominant action on µ receptors: morphine, codeine, fentanyl, methadone, oxycodone and hydromorphone.

Opioids are usually prescribed together with NSAIDs. This way the analgesic effect is more intensive and occurs by different mechanisms, in addition to preventing the use of high doses of both classes of drugs and to decreasing adverse effects intensity.

Local anesthetics

Local anesthetics may be indicated for different objectives. They are administered by different routes and sites to manage acute pain. They are used alone or in association with other drugs to decrease latency, and to increase analgesic effect duration or intensity. Venous lidocaine has been used in different surgical procedures20-24.

Others

Other drugs which may be used are: ketamine, dexmedetomidine, clonidine, steroids, gabapentin and pregabalin. Steroids may also promote beneficial effects in multimodal perioperative analgesia25-27. Gabapentinoids have been used as part of multimodal postoperative analgesia28-32.

Regional analgesia

Regional analgesia decreases the use of opioids, decreasing the high incidence of postoperative vomiting. Local analgesia should be used for all pediatric anesthetic procedures where there is no contraindication because it is effective and safe. Peripheral nervous blocks are also used and the most popular are penile, ileoinguinal, ileo-hypogastric and greater auricular nerve blocks33. Ultrasound (US) guided blocks enable the visualization of studied structures and desired site for local anesthetic injection, thus assuring efficacy. Success rate is higher with a substantially lower volume as compared to conventional techniques34,35. Caudal epidural block is widely used in pediatric anesthesia and has a critical role in postoperative analgesia for pediatric outpatient procedures36. In general, 0.125%-0.25% bupivacaine is used. Other drugs are opioids and alpha-2 agonists37.

Local anesthetics infiltration

This analgesic technique has been used for decades. It may be a bolus injection or an infusion catheter may be maintained. Catheters are placed in the surgical wound, fascia, intra-articular and intra-abdominal regions for local anesthetic infusion or bolus injection.

Catheters have been used in different ways according to the needs of outpatient procedures, such as intra-abdominal, subfascial, subcutaneous, intra-articular, interpleural, substernal and perineural39. High volumes of anesthetics with or without adjuvants may be also infiltrated in different section planes in the intraoperative period38. Continuous local anesthetic infusion via catheter in the surgical wound promotes effective postoperative analgesia with decreased opioid consumption and consequently decreasing adverse effects and improving patients' satisfaction39.

Local anesthetics infusion is becoming increasingly popular to control moderate to severe POP in large-sized orthopedic outpatient surgeries40-43. However, the specific benefits of this technique should be counterbalanced with equipment costs and resources for its safe use outside the hospital.

Transcutaneous electric nerve stimulation (TENS)

TENS has been used in association to analgesics to relief POP and acts through the activation of pain suppressing system44. Electrodes may be placed on paravertebral dermatomes corresponding to the surgical incision or on acupoints45.

Multimodal analgesia

This is a technique aiming at POP relief with the association of drugs and analgesic techniques. It involves the combined administration of anti-inflammatory, opioids and other drugs acting on different sites in both nervous system central and peripheral pathways. The objective of this association is to improve pain control preventing adverse effects. Multimodal analgesia to prevent outpatient POP is the key element for the recovery process, decreasing late hospital discharges and, most importantly, helping patients' return to their activities the day after1,26,46-48.

Multimodal treatment should be effective for pain relief, should induce minimum adverse effects, should be safe and easily handled both by patients and caregivers49.

Pain pathophysiology has multiple mechanisms and there is the need for multimodal or balanced treatment, of analgesics with additive or synergistic effects50. Multimodal analgesia should be adjusted to supply individual needs of patients, taking into consideration their medical history, associated diseases, type of proposed surgery and previous experiences related to the management of both chronic and acute pain.

 

SURGERIES PARTICULARITIES

General surgery

Videolaparoscopy

In a study, celecoxib (400 mg/d) has decreased POP scores and analgesic needs for 24h to 48h, and has provided faster functional recovery, even for daily activities9. Preoperative 1 g intravenous paracetamol has decreased the opioid dose needed to control POP, helping the recovery of patients submitted to cholecystectomy51. With 4 mg intravenous dexamethasone for patients submitted to anorectal surgeries there has been earlier hospital discharge52. Pregabalin, in a single oral dose of 150 mg has relieved POP in patients submitted to cholecystectomy53.

A multimodal analgesia regimen consisting of preoperative oral 150 mg pregabalin, 975 mg paracetamol and 400 mg celecoxib was effective to decrease the use of intra and postoperative opioids in patients submitted to robotic-assisted prostatectomy54.

Intraperitoneal administration of local anesthetics for cholecystectomy has relieved POP. Authors have concluded that intraperitoneal local anesthetics are well tolerated and results are promising to control early postoperative abdominal pain55.

Inguinal hernia repair

With local anesthetics infiltration in surgical wound, superior postoperative analgesia was observed in a study with 0.5% bupivacaine subfascial infusion as compared to oral analgesics as single therapy56.

In a different study, local anesthetics infusion after inguinal hernia repair has decreased pain scores as compared to placebo. However, these effects are limited to the first postoperative day57.

Anorectal surgery

For anorectal surgeries, authors have observed that with perianal local anesthetics infiltration patients were safely qualified for hospital discharge with low incidence of urinary retention58.

Gynecological surgeries

Videolaparoscopy

Preoperative intravenous 1 g paracetamol decreases opioid doses needed to control POP, helping the recovery of patients submitted to hysterectomy59. In a study, preoperative oral 300 mg pregabalin did not improve POP in patients submitted to minor gynecological procedures60,61. In a different study with high pregabalin doses there has been a higher incidence of sedation62. Multimodal analgesia with subarachnoid local anesthetics and opioids, and intravenous NSAIDs was excellent with minor side effects63. Surgical wound infiltration with local anesthetics has significantly decreased the need for opioids after gynecological laparoscopic surgeries64.

Breast reconstruction

For breast reconstruction, levobupivaine injected in the incision site every 3h, as supplement to oral paracetamol, has resulted in effective analgesia65.

Abdominal hysterectomy

Bupivacaine infusion in the surgical wound above the fascia, in patients submitted to hysterectomy, has improved postoperative pain control for 12h as compared to infusion below the fascia66.

Orthopedic surgery

Spinal procedures

Preoperative gabapentin was effective to improve POP control for children and adolescents submitted to spinal procedures67.

Total hip arthroplasty

The combination of 1200 mg gabapentin, 8 mg dexamethasone and 0.15 mg.kg-1 ketamine, plus 1 g paracetamol and 15 mg ketorolac has decreased pain scores in patients submitted to total hip replacement, as compared to paracetamol and ketorolac alone. However, there has been no decrease in morphine needs68. Pregabalin (300 mg) has promoted chronic neuropathic pain relief after total hip replacement when administered before surgery and for 14 days after procedures (150-50 mg twice a day). In addition to decreasing opioid needs, these patients had improvement in rehabilitation in the first 30 days69.

Total knee replacement

Local infiltration with 400 mg ropivacaine and 30 mg ketorolac has relieved pain and decreased morphine consumption for total knee replacement70. Intracapsular local anesthetic was as effective as intra-articular local anesthetics71. Ropivacaine and morphine infusion has decreased POP and helped rehabilitation70,73. With local infiltration there has been lower morphine consumption and lower pain intensity as compared to placebo74.

Knee arthroscopy

In a systematic review, joint infiltration with local anesthetics has promoted decreased POP75. Ketamine and morphine with ropivacaine had analgesic effect without increasing adverse effects76.

Ligament reconstruction

Treatment may be multimodal with NSAIDs, intra-articular injection, ketamine, nervous block, cryotherapy and opioids77. NSAIDs decrease POP78.

Shoulder surgery

Brachial plexus block and intra-articular anesthetic infiltration are superior to surgery wound anesthetic infiltration, suprascapular nervous block and intravenous patient-controlled analgesica (PCA)79. One may perform intrabursal and subacromial local anesthetic injection via PCA80. Morphine and bupivacaine infusion has been used for post-arthroscopy pain relief81.

ENT surgery

The association of paracetamol and NSAIDs promotes better analgesia then each drug separately82. Ketorolac may be used intranasally83. Bupivacaine infiltration is effective for adenotonsylectomy84.

Pediatric surgery

Hernia repair

For inguinal hernia repair, local anesthetic infiltration of the surgical wound has promoted decrease POP85. The association of 1 mg.kg-1 ketorolac and 20 mg.kg-1 paracetamol was effective for inguinal hernia repair86.

 

CONCLUSION

Effective pain control is paramount in outpatient surgeries and aims not only at comfort, but also at decreasing complication rates and providing early rehabilitation. Multimodal analgesia is beneficial to patients, however the treatment should be tailored since there are several drugs and technique for pain relief.

 

REFERENCES

1. Pavlin DJ, Chen C, Penazola DA, et al. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg. 2002;95(3):627-34.         [ Links ]

2. Segerdahl M, Warrén-Stomberg M, Rawal N, et al. Clinical practice and routines for day surgery in Sweden: results from a nation-wide survey. Acta Anaesthesiol Scand. 2008;52(1):117-24.         [ Links ]

3. White PF. Pain management after ambulatory surgery. Where is the disconnect? Can J Anaesth. 2008;55(4):201-7.         [ Links ]

4. Meridy HW. Criteria for selection of ambulatory surgical patients and guidelines for anesthetic management: A retrospective study of 1553 cases. Anesth Analg. 1982;61(11):921-6.         [ Links ]

5. Lammers PK, Palmer PN. Surgeons discuss ambulatory surgery, legislative concerns, dangers of transfusions, surgical advances. AORN J 1991;53(1):16-29.         [ Links ]

6. Osborne GA, Rudkin GE. Outcome after day-care surgery in a major teaching hospital. Anaesth Intensive Care. 1993;21(6):822-7.         [ Links ]

7. Warner MA, Shields SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia. JAMA 1993;270(12):1437-41.         [ Links ]

8. Recart A, Issioui T, White PF, et al. The efficacy of celecoxib premedication on postoperative pain and recovery times after ambulatory surgery: a dose-ranging study. Anesth Analg. 2003;96(6):1631-5.         [ Links ]

9. White PF, Sacan O, Tufanogullari B, et al. Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery. Can J Anaesth. 2007;54(5):342-8.         [ Links ]

10. Gan TJ, Joshi GP, Viscusi E, et al. Preoperative parenteral parecoxib and follow-up oral valdecoxib reduce length of stay and improve quality of patient recovery after laparoscopic cholecystectomy surgery. Anesth Analg. 2004;98(6):1665-73.         [ Links ]

11. Avellaneda C, Gomez A, Martos F, et al. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propacetamol 1 g on haemodynamic parameters and postoperative pain after heart surgery. Eur J Anaesthesiol. 2000;17(2):85-90.         [ Links ]

12. Edwards JE, Meseguer F, Faura CC, et al. Single-dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev. 2001;(3):CD003227.         [ Links ]

13. Alves D, Duarte I. Involvement of ATP-sensitive K(+) channels in the peripheral antinociceptive effect induced by dipyrone. Eur J Pharmacol. 2002;444(1-2):47-52.         [ Links ]

14. Sachs D, Cunha FQ, Ferreira SH. Peripheral analgesic blockade of hypernociception: activation of arginine/NO/cGMP/protein kinase G/ATP-sensitive K+ channel pathway. Proc Natl Acad Sci U S A. 2004;101(10):3680-5.         [ Links ]

15. Simmons DL. Variants of cyclooxygenase-1 and their roles in medicine. Thromb Res. 2003;110(5-6):265-8.         [ Links ]

16. Schug SA. Clinical pharmacology of non-opioid and opioid analgesics. Pain - An Updated Review: Refresher Course Syllabus, Seatle: ASP Press; 2005. p. 31-40.         [ Links ]

17. Graham GG, Scott KF. Mechanism of action of paracetamol. Am J Ther. 2005;12(1):46-55.         [ Links ]

18. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004;43(13):879-923.         [ Links ]

19. Mattia C, Coluzzi F. Tramadol. Focus on musculoskeletal and neuropathic pain. Minerva Anesthesiol. 2005;71(10):565-84.         [ Links ]

20. Koppert W, Weigand M, Neumann F, et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg. 2004;98(4):1050-5.         [ Links ]

21. Wu CT, Borel CO, Lee MS, et al. The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg. 2005;100(2):448-53.         [ Links ]

22. Kaba A, Laurent SR, Detroz BJ, et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007;106(1):11-8.         [ Links ]

23. Herroeder S, Pecher S, Schönherr ME, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007;246(2):192-200.         [ Links ]

24. Oliveira CMB, Issy AM, Sakata RK. Lidocaína por via venosa intraoperatória. Rev Bras Anestesiol. 2010;60(3):320-7.         [ Links ]

25. White PF. Multimodal pain management-- the future is now! Curr Opin Investig Drugs. 2007;8(7):517-8.         [ Links ]

26. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5 Suppl):S5-22.         [ Links ]

27. Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am. 2006;88(6):1361-72.         [ Links ]

28. Gilron I, Orr E, Tu D, et al. A randomized, double-blind, controlled trial of perioperative administration of gabapentin, meloxicam and their combination for spontaneous and movement-evoked pain after ambulatory laparoscopic cholecystectomy. Anesth Analg. 2009;108(2):623-30.         [ Links ]

29. Srivastava U, Kumar A, Saxena S, et al. Effect of preoperative gabapentin on postoperative pain and tramadol consumption after minilap open cholecystectomy: a randomized double-blind, placebo-controlled trial. Eur J Anaesthesiol. 2010;27(4):331-5.         [ Links ]

30. Sen H, Sizlan A, Yanarates O, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg. 2009;109(5):1645-50.         [ Links ]

31. Clarke H, Pereira S, Kennedy D, et al. Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty. Pain Res Manag. 2009;14(3):217-22.         [ Links ]

32. Clivatti J, Sakata RK, Issy AM. Revisão sobre uso de gabapentina para controle da dor pós-operatória. Rev Bras Anestestesiol. 2009;59(1):87-98.         [ Links ]

33. Kundra P, Sivashanmugam, Ravishankar M. Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in children. Acta Anaesthesiol Scand. 2006;50(5):622-6.         [ Links ]

34. Willschke H, Marhofer P, Bosenberg A, et al. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005;95(2):226-30.         [ Links ]

35. Willschke H, Bosenberg A, Marhofer P, et al. Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg. 2006;102(6):1680-4.         [ Links ]

36. Ansermino M, Basu R, Vandebeek C, et al. Nonopioid additives to local anaesthetics for caudal blockade in children: a systematic review. Paediatr Anaesth. 2003;13(7):561-73.         [ Links ]

37. Sanders JC. Paediatric regional anaesthesia, a survey of practice in the United Kingdom. Br J Anaesth. 2002;89(5):707-10.         [ Links ]

38. Gupta A. Wound infiltration with local anaesthetics in ambulatory surgery. Curr Opin Anesthesiol. 2010,23(6):708-13.         [ Links ]

39. Liu SS, Richman JM, Thirlby RC, et al. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203(6):914-32.         [ Links ]

40. White PF, Issioui T, Skrivanek GD, et al. Use of a continuous popliteal sciatic nerve block for the management of pain after major podiatric surgery: does it improve quality of recovery? Anesth Analg. 2003;97(5):1303-9.         [ Links ]

41. Ilfeld BM, Enneking FK. Continuous peripheral nerve blocks at home: a review. Anesth Analg. 2005;100(6):1822-33.         [ Links ]

42. Ilfeld BM, Le LT, Ramjohn J, et al. The effects of local anesthetic concentration and dose on continuous infraclavicular nerve blocks: a multicenter, randomized, observer-masked, controlled study. Anesth Analg. 2009;108(1):345-50.         [ Links ]

43. Capdevilla X, Dadure C, Bringuier S, et al. Effect of patient-controlled perineural analgesia on rehabilitation and pain after ambulatory orthopedic surgery: a multicenter randomized trial. Anesthesiology. 2006;105(3):566-73.         [ Links ]

44. Ferreira FC, Issy AM, Sakata RK. Avaliação do efeito da estimulação elétrica transcutânea (TENS) para analgesia pós-operatória. Rev Bras Anestesiol. 2011;61(5):561-7.         [ Links ]

45. Chen L, Tang J, White PF, et al. The effect of location of transcutaneous electrical nerve stimulation on postoperative opioid analgesic requirement: acupoint versus nonacupoint stimulation. Anesth Analg. 1998;87(5):1129-34.         [ Links ]

46. White PF, Kehlet H, Neal JM, et al. Role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007;104(6):1380-96.         [ Links ]

47. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85(4):808-16.         [ Links ]

48. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007;105(1):205-21.         [ Links ]

49. Elvir-Lazo OL, White PF. Postoperative pain management after ambulatory surgery: role of multimodal analgesia. Anesthesiol Clin. 2010;28(2):217-24.         [ Links ]

50. White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues? Anesthesiology. 2010;112(1):220-5.         [ Links ]

51. Salihoglu Z, Yildirim M, Demiroluk S, et al. Evaluation of intravenous paracetamol administration on postoperative pain and recovery characteristics in patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2009;19(4):321-3.         [ Links ]

52. Coloma M, Duffy LL, White PF, et al. Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesth Analg. 2001;92(1):85-8.         [ Links ]

53. Agarwal A, Gautam S, Gupta D, et al. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 2008;101(5):700-4.         [ Links ]

54. Trabulsi EJ, Patel J, Viscusi ER, et al. Preemptive multimodal pain regimen reduces opioid analgesia for patients undergoing robotic-assisted laparoscopic radical prostatectomy. Urology. 2010;76(5):1122-4.         [ Links ]

55. Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg. 2006;103(3):682-8.         [ Links ]

56. Lau H, Patil NG, Lee F. Randomized clinical trial of postoperative subfascial infusion with bupivacaine following ambulatory open mesh repair of inguinal hernia. Dig Surg. 2003;20(4):285-9.         [ Links ]

57. Schurr MJ, Gordon DB, Pellino TA, et al. Continuous local anesthetic infusion for pain management after outpatient inguinal herniorrhaphy. Surgery. 2004;136(4):761-9.         [ Links ]

58. Lohsiriwat V, Lohsiriwat D. Ambulatory anorectal surgery under perianal anesthetics infiltration: analysis of 222 cases. J Med Assoc Thai. 2007;90(2):278-81.         [ Links ]

59. Jokela R, Ahonen J, Seitsonen E, et al. The influence of ondansetron on the analgesic effect of acetaminophen after laparoscopic hysterectomy. Clin Pharmacol Ther. 2010;87(6):672-8.         [ Links ]

60. White PF, Tufanogullari B, Taylor J, et al. The effect of pregabalin on preoperative anxiety and sedation levels: a dose-ranging study. Anesth Analg. 2009;108(4):1140-5.         [ Links ]

61. Paech MJ, Goy R, Chua S, et al. A randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minor gynecological surgery. Anesth Analg. 2007;105(5):1449-53.         [ Links ]

62. Chang SH, Lee HW, Kim HK, et al. An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy. Anesth Analg. 2009;109(4):1284-6.         [ Links ]

63. Belzarena SD, Alves MT, Cucco ML, et al. Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam Rev Bras Anestesiol. 2005;55(2):158-64.         [ Links ]

64. Fong SY, Pavy TJ, Yeo ST, et al. Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy. Reg Anesth Pain Med. 2001;26(2):131-6.         [ Links ]

65. Legeby M, Jurell G, Beausang-Linder M, et al. Placebo-controlled trial of local anaesthesia for treatment of pain after breast reconstruction. Scand J Plast Reconstr Surg Hand Surg. 2009;43(6):315-9.         [ Links ]

66. Hafizoglu MC, Katircioglu K, Ozkalkanli MY, et al. Bupivacaine infusion above or below the fascia for postoperative pain treatment after abdominal hysterectomy. Anesth Analg. 2008;107(6):2068-72.         [ Links ]

67. Rusy L, Hainsworth KR, Nelson TJ, et al. Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg. 2010;110(5):1393-8.         [ Links ]

68. Rasmussen ML, Mathiesen O, Dierking G, et al. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study. Eur J Anaesthesiol. 2010;27(4):324-30.         [ Links ]

69. Mathiesen O, Jacobsen LS, Holm HE, et al. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth. 2008;101(4):535-41.         [ Links ]

70. Essving P, Axelsson K, Kjellberg J, et al. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop. 2010;81(3):354-60.         [ Links ]

71. Andersen LO, Husted H, Kristensen BB, et al. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty. Anaesthesia. 2010; 65(9):904-12.         [ Links ]

72. Rasmussen S, Kramhøft MU, Sperling KP, et al. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand. 2004;75(5):606-9.         [ Links ]

73. Andersen LO, Husted H, Otte KS, et al. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand. 2008;52(10):1331-5.         [ Links ]

74. Essving P, Axelsson K, Kjellberg J, et al. Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. Acta Orthop. 2009;80(2):213-9.         [ Links ]

75. Møiniche S, Mikkelsen S, Wetterslev J, et al. A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesth Pain Med. 1999;24(5):430-7.         [ Links ]

76. Gupta A, Axelsson K, Allvin R, et al. Postoperative pain following knee arthroscopy: the effects of intra-articular ketorolac and/or morphine. Reg Anesth Pain Med. 1999;24(3):225-30.         [ Links ]

77. De Lathouwer C, Poullier JP. How much ambulatory surgery in the World in 1996-1997 and trends? Ambul Surg. 2000;8(4):191-210.         [ Links ]

78. Reuben SS, Ekman EF, Charron D. Evaluating the analgesic efficacy of administering celecoxib as a component of multimodal analgesia for outpatient anterior cruciate ligament reconstruction surgery. Anesth Analg. 2007;105(1):222-7.         [ Links ]

79. Beaudet V, Williams SR, Tétreault P, et al. Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery. Reg Anesth Pain Med. 2008;33(2):134-8.         [ Links ]

80. Axelsson K, Nordenson U, Johanzon E, et al. Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol Scand. 2003;47(8):993-1000.         [ Links ]

81. Park JY, Lee GW, Kim Y, et al. The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg Anesth Pain Med. 2002;27(2):145-9.         [ Links ]

82. Issioui T, Klein KW, White PF, et al. The efficacy of premedication with celecoxib and acetaminophen in preventing pain after otolaryngologic surgery. Anesth Analg. 2002;94(5):1188-93.         [ Links ]

83. Grant GM, Mehlisch DR. Intranasal ketorolac for pain secondary to third molar impaction surgery: a randomized, double-blind, placebo-controlled trial. J Oral Maxillofac Surg. 2010;68(5):1025-31.         [ Links ]

84. Sun J, Wu X, Meng Y, et al. Bupivacaine versus normal saline for relief of postadenotonsillectomy pain in children: a meta-analysis. Int J Pediatr Otorhinolaryngol. 2010;74(4):369-73.         [ Links ]

85. Ausems ME, Hulsewe KW, Hooymans PM, et al. Postoperative analgesia requirements at home after inguinal hernia repair: effects of wound infiltration on postoperative pain. Anaesthesia. 2007;62(4):325-31.         [ Links ]

86. Hong JY, Won Han S, Kim WO, et al. Fentanyl sparing effects of combined ketorolac and acetaminophen for outpatient inguinal hernia repair in children. J Urol. 2010;183(4):1551-5.         [ Links ]

 

 

Correspondence to:
Rioko Kimiko Sakata, M.D
Rua Três de Maio 61/51 - Vila Clementino
04044-020 São Paulo, SP
E-mail: riokoks.dcir@epm.br

Submitted in February 28, 2012.
Accepted for publication in December 18, 2012.

 

 

* Received from Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP). São Paulo, SP.

Creative Commons License Todo o conteúdo deste periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons