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CLINICIAN'S CORNER
Multimodal Pain Management Strategies for Office-Based and Ambulatory Procedures
James C. Crews, MD
JAMA. 2002;288:629-632.
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INTRODUCTION
Office-based surgical procedures account for up to 25% of all elective surgical procedures performed in the United States.1 Ambulatory surgical procedures now make up 70% of the total volume of hospital-based elective surgical procedures.2 More major surgical procedures are being performed on an ambulatory or 23-hour hospital stay basis including intra-abdominal, intrathoracic, and major orthopedic procedures. Postoperative pain, nausea, and vomiting are the most common factors leading to delays in outpatient discharge and admissions to the hospital following ambulatory surgery.3-4 An understanding of the pharmacologic concepts and pain management techniques for those office-based procedures performed within the scope of a primary care practice, and for patients undergoing hospital-based ambulatory (outpatient) surgical procedures, is a crucial component in the continuing education of the primary care physician.
Opioid analgesics are the historical choice of primary analgesic medications for postoperative pain. It has been well documented that . . . [Full Text of this Article]
Patient Education and Preoperative Considerations
Nonopioid Analgesics
Local Anesthetic Techniques
Opioid Analgesics
Ladder of Therapy for Multimodal Postoperative Analgesia
Alternative Nonpharmacologic Therapies
Consultation of a Pain Management Specialist
Future Considerations
Conclusion
Author Affiliation: Department of Anesthesiology, Acute Pain Service, Wake Forest University School of Medicine, Winston-Salem, NC.
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