Page 131 Guide to Pain Management in Low-Resource Settings

Chapter 16

Pain Management in Ambulatory/Day Surgery

Andrew Amata

Case report should be given at regular intervals for the fi rst 48 hours,
and oral tramadol or codeine ordered as required (rescue
John, a 5-year-old boy, had an orchidopexy done un- analgesia) for unrelieved moderate to severe pain.
der general anesthesia. Th e perioperative period was
uneventful, and the child (accompanied by his moth-
er) was discharged home, fully awake and comfortable Why is analgesia for minor
about 5 hours after the procedure with a prescription surgical procedures a topic
of oral paracetamol (acetaminophen). Problems began worth reading about ?
later that night when the child woke up complaining of
signifi cant pain around the operation site. Th e mother In this section, I will explain why pain may be a com-
gave him the prescribed analgesic, but the pain per- mon and signifi cant problem in seemingly minor sur-
sisted, and the child had now become inconsolable and gical procedures and how such pain can be eff ectively
unable to go back to sleep, keeping the parents and the managed. Postoperative pain should be considered a
other siblings awake. complication of surgery with signifi cant adverse eff ects,
Th is sort of scenario is unfortunately very com- and every eff ort should therefore be made to avoid or
mon and causes unnecessary pain, distress, and suff er- minimize it. It is obvious that there are various options
ing, not only to the patient but often to the whole house- for providing eff ective and safe analgesia after minor
hold. Th e good news is that this type of situation is easily surgical procedures. Satisfactory analgesia should be
preventable or at least eff ectively treatable in most cases feasible for every patient, irrespective of geographical
by applying simple and safe methods of pain relief. location or level of resources.
For our illustrative case above, an example of a
typical pharmacological analgesia therapy can be as fol- What is minor surgery?
lows. Paracetamol and/or a nonsteroidal anti-infl am-
matory drug (NSAID) is given orally as a premedication Surgery is commonly classifi ed as major or minor de-
about 1 hour before surgery or as a suppository after in- pending on the seriousness of the illness, the parts of
duction of anesthesia. A caudal block or a fi eld block or the body aff ected, the complexity of the operation, and
local infi ltration with bupivacaine or ropivacaine local the expected recovery time. Minor surgical procedures
anesthetic is administered after induction of anesthe- now constitute the majority of procedures carried out
sia. Postoperatively, oral paracetamol and/or an NSAID in health care facilities because of greater awareness and

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 119
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.