Managing Pain After Ambulatory Surgery

In a study that focused on the predischarge period, the length of stay increased significantly with increasing pain severity, time required to treat pain, and total opioid (fentanyl) dose administered. During this period, 20% of women and 12.5% of men reported severe pain. High doses of opioids were associated with longer recovery times and a greater incidence of nausea and vomiting.

The second study, which focused on the period after discharge, showed that pain and the side effects of opioids caused significant patient distress, limited activity, and reduced patient satisfaction. After returning home, 24% of women and 32% of men experienced severe pain. Fewer than half were able to return to normal activity within 48 hours.

An investigational injectible medication called parecoxib may meet the need for better pain management in ambulatory surgery patients. Its developer, Pharmacia (Pea Pack, NJ, USA) states it is more effective than a 4- mg dose of the injectible narcotic analgesic morphine. Parecoxib combats pain and inflammation by targeting the cyclooxygenase (COX)-2 enzyme, which is activated at sites of injury. Compared to narcotics, this type of medication is much less likely to produce nausea, vomiting, ileus, and central nervous system effects. Compared to conventional nonsteroidal anti-inflammatory drugs (NSAIDS), COX-2 inhibitors are less likely to cause gastrointestinal ulceration or reduced blood clotting.

"There has been a long-standing need for safer and better-tolerated acute pain medications,” said D.J. Pavlin, M.D., University of Washington (USA). "Nowhere is this need more urgent than in outpatient settings.”