Challenges of pain control in ambulatory surgery setting

Ambulatory surgery centers (ASCs) are prevalent throughout the United States and provide benefits to both patients and healthcare systems. Accordingly, ASCs have anesthetic challenges that are unique from hospitals in providing optimal patient care. Success of these centers is predicated on same-day patient discharge while maintaining patient safety and comfort. Adequate control of analgesia and postoperative nausea and vomiting remain two fundamental challenges of achieving this goal. Regional anesthetic techniques in combination with multimodal analgesia and enhanced recovery protocols aid in this process. Failure to meet these objectives may result in delayed discharge or escalation of care resulting in hospital admission. We present an overview of the causes of inadequate analgesia in ASCs, major postoperative concerns, regional anesthetic techniques to aid in recovery and discharge, and fundamentals of appropriate discharge analgesia.