[Pain management after ambulatory surgery in Germany]

An increasing percentage of surgical procedures are performed in an ambulatory setting. However, a fairly high number of patients experience moderate to severe postoperative pain and pain is a common reason for unanticipated hospital admission. An adequate postoperative pain therapy in the ambulatory setting is therefore essential not only for ethical reasons or improvements in recovery but also for economic reasons but - in Germany - still remains inadequate. The following article deals with the problems that cause inadequat pain therapy after ambulatory surgery in Germany and introduces different therapeutic options, strategies and drugs relevant to optimize pain therapy after ambulatory surgery. Major aspects are education of the patient, the use of adequate non-opioid analgesics and implementation of regional analgesia techniques. Non-opioid analgesics are known to be effective to reduce opioid requirements and side effects; however, not all non-opioid analgesics are similar effective. Furthermore side effects and risks of these drugs need to be considered in individual patients. Benefits from regional anesthesia and analgesia techniques are well known after sugery. Experiences from other countries demonstrate improved analgesia, less side effects (e.g. sedation, insomnia) and increased patients satisfaction associated with continuous peripheral nerve blocks at home. In Germany, these techniques are not frequently used but need to be considered in the future to optimize postoperative pain management after ambulatory surgery.