POSTOPERATIVE PAIN IN AMBULATORY SURGERY

Postoperative pain is a common reason for the delayed discharge and un anticipated hospital admission of outpatients. In this study, we exami ned the pattern of pain in ambulatory surgical patients and determined those factors that predict postoperative pain. Ten thousand eight con secutive ambulatory surgical patients were prospectively studied. Preo perative patient characteristics, intraoperative variables, and pain i n the postanesthesia care unit (PACU) and the ambulatory surgical unit (ASU) and 24 h postoperatively were documented. The incidence of seve re pain was 5.3% in the PACU, 1.7% in the ASU, and 5.3% 24 h postopera tively. In the PACU, younger male adults (36 +/- 13 vs 47 +/- 22 yr), ASA physical status I patients, and patients with a higher body mass i ndex (26 +/- 5 vs 25 +/- 5 kg) had a higher incidence of severe pain. in the group with severe pain, the duration of anesthesia, the duratio n of stay in the PACU and the ASU, and the time to discharge was longe r than in the group without severe pain. In the PACU, orthopedic patie nts had the highest incidence of pain (16.1%), followed by urologic (1 3.4%), general surgery (11.5%), and plastic surgery (10.0%) patients. In patients who had general anesthesia, the intraoperative dose of fen tanyl was significantly smaller in the group with severe pain than in the group without severe pain when body mass index and duration of ane sthesia were taken into consideration. Body mass index, duration of an esthesia, and certain types of surgery were significant predictors of severe pain in the PACU. This knowledge will allow us to identify thos e patients at risk of severe postoperative pain and manage them prophy lactically. Implications: The pattern of pain was examined in 10,008 c onsecutive ambulatory surgical patients. The incidence of severe pain was 5.3% in the postanesthesia care unit, 1.7% in the ambulatory surgi cal unit, and 5.3% 24 h postoperatively. Body mass, duration of anesth esia, and certain types of surgery were significant predictors of pain in the postanesthesia care unit. These data will allow us to better p redict those patients who need intense prophylactic analgesic therapy.