An update on the management of pain after day surgery

Dr Ian Jackson,
Clinical Director,
Theatres,
Anaesthetics and Intensive Care,
York Hospitals NHS Foundation Trust

Biography
I qualified from Aberdeen Medical School in 1981.  I was appointed as a Consultant Anaesthetist in York in 1989 and helped start one of the first Acute Pain Services in the UK.  In 1991 I became responsible for the development of Day Surgery in York.  I am the Clinical Director for Anaesthesia, ICU and Theatres and have led the redesign of short stay surgery in York with the opening of a 6 theatre day unit that includes a 22 trolley overnight stay area.
 
I was elected to the Council of the British Association of Day Surgery (BADS) in 1994, was the Honorary Treasurer (1997 –2000) and was the Editor of the Journal of One-Day Surgery (2000-2004).  I introduced and ran the BADS website (www.bads.co.uk) for many years and was their President 2006-2008.

Abstract
During this talk I will start by describing the ever expanding challenges that we are facing in our day surgery units.  In particular the procedures that are now feasible as a day case depends not only on advanced surgical techniques, but also on the skills of the anaesthetists.  Some anaesthetists regard day surgery as being of little interest – indeed many like the sense of excitement of ‘major surgery’ dealing with trauma or vascular surgery.  This is unfortunate as day surgery requires the careful management of patients and for the more challenging cases requires the optimisation of fluid therapy and the management of post operative nausea, vomiting and pain.  We complain when anaesthetic colleagues come to the day unit and apply their inpatient anaesthetic techniques to this population.  I suggest this is no longer acceptable and that what we are criticising is ‘lazy practice’ and I teach our trainees that they should apply the principles of day surgery anaesthesia to all their patients.  We should look at every patient we manage and consider why do they need an intravenous infusion postoperatively and plan how we can manage their pain with oral analgesia and local anaesthetic techniques.

During my talk I will explain some of the help that is available to help us manage these more challenging cases and review some of the current drugs that are being used.  Gabapentin is currently topical and I will review the evidence around its use.  Finally I will look at some of the more unusual possibilities that may offer opportunities for the future management of pain in day surgery.

References
                                                                       

• www.postoppain.org
• Novel Approaches to Postoperative Analgesia for Day Case Surgery: A review. Mccleane G. The Journal of One-Day Surgery 2008;18(1):4-8
• Bandolier Website www.medicine.ox.ac.uk/bandolier/Extraforbando/APain.pdf
• Turan A, Memis D, Karamanlioglu B, Yagiz R, Pamukcu Z, Yavuz E. The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery. Anesth Analg 2004; 99: 375–78