Focus on quality: Managing pain and PONV in day surgery

SummaryThe management of pain, nausea and vomiting after day surgery remains a challenge, especially once the patient has been discharged back to their own home. Optimum pain relief requires a variety of measures, including appropriate patient preparation and a multi-modal analgesia strategy combining local anaesthesia with non-opioid analgesia. Pain relief should be administered prophylactically such that patients should rarely awaken in severe pain. The use of peri-operative opioids should be minimised, since these agents increase nausea and sedation and do not add worthwhile additional analgesia if all other measures have been taken. However, intermediate-acting opioids do have a role in providing “rescue” analgesia in a minority of cases.Postoperative nausea and vomiting (PONV) remains a common problem after day surgery, which can compromise recovery and even discharge in extreme cases. PONV has multiple causes and also multiple therapies, none of which are entirely effective. Many of the risk factors for PONV are predictable and measures should be taken to minimise PONV in all patients, with additional prophylaxis given selectively to the more susceptible, including combination therapy for those at the highest risk.Following discharge, patients are best able to manage their own symptoms of pain and PONV if they are provided with take-home medication and clear written information about available treatments, their side effects and where to obtain further supplies and advice, if needed.