[Analgesia in pediatric outpatient surgery]

A number of surgical procedures for pediatric patients can be suitably performed in an outpatient setting. The advantages are impressive: reduced costs, lower rate of infection, avoidance of hospitalization with the inherent psychological stress, and timely return of the patients to their familiar home environment. An essential feature of the quality of outpatient surgery is the efficacy of the perioperative pain therapy for which a multimodal approach has proven to be very effective: workflow tailored to children's needs, ambiance appropriate for children, and pharmacological analgesia. In the preliminary counseling session it is imperative that parents and children receive detailed information on procedures (role playing, modeling). Associated unpleasant factors prior to induction of anesthesia should be avoided. The primary element of pharmacological analgesia is regional anesthesia; additional options are paracetamol, nonsteroidal antirheumatic agents (be aware of the highest dosages!), and opioids. When opioids are employed, care should be taken that monitoring standards in the recovery room are not lowered and include pulsoxymetry. Because of the clearly elevated rate of postoperative nausea and vomiting related to perioperative administration of opioids, the lower dosage level should be chosen. This article presents concepts of perioperative analgesia.