Perioperative pain and post-operative nausea and vomiting (PONV) management after day-case surgery: The SFAR-OPERA national study

Abstract

Objectives: Since pain and postoperative nausea and vomiting (PONV) are the main reasons for failed discharge after day-case surgery, assessing pain and PONV is important. The aim was to describe the perioperative pain and PONV management within selected day-case surgical procedures in France. Methods: The OPERA trial was carried out on given days between December 2013 and December 2014. Each participating centre was required to fill out 3 separate questionnaires aiming at describing (1) protocols about pain and PONV, (2) patients' characteristics and procedures, (3) analgesic and PONV practice patterns for selected procedures. Results: Over the two days of investigation in each of the 221 randomly selected healthcare institutions, 7382 patients were included, of whom 2144 patients above 12 years underwent one of 10 selected procedures. Among responding institutions, 40% [33;47] had a dedicated pain management written protocol. Combination of tramadol and paracetamol was the most commonly prescribed (78% [71;83] of centres). Oral morphine was prescribed in 59/199 (30% [23; 37]) centres, for home treatment in 25/59 (42% [30; 56]) centres. However, there was no standardised take-home analgesic and PONV strategies for selected surgical procedures at risk of moderate to severe pain. PONV management guidance after discharge was included in only 12 % of centres. Conclusion: This survey demonstrates that practice patterns for pain treatment and PONV prophylaxis after ambulatory surgery vary among French centres and are not always in line with national guidelines. Strategies to improve practices and make them more homogeneous are necessary.

Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart Angel™ app and an original web platform for patients following outpatient surgery: a prospective observational pilot study

“…This may suggest that optimal monitoring should be begun from the evening of Day 0 to the evening of Day 3 (with systematic measurements morning, noon and evening) and at least one measurement per day from Day 3 onwards to optimize patient adherence. Interestingly, the peak of postoperative complications classically occured between Day 1 and Day 3 [7].…”

“…[1,2]. However, safety and adverse events with these procedures remain debated in the literature with regard to potential medical or surgical complications at home [3][4][5][6][7]. Recently, digital technologies have been proposed to remotely monitor outpatients at home and in hospital in order to detect patients with early signs of disease progression or deterioration [8][9][10].…”

Pain management after ambulatory surgery: a prospective, multicenter, randomized, double-blinded parallel controlled trial comparing nalbuphine and tramadol

“…Numerous studies [17,18] have shown that after day surgery nearly 80% of patients experience pain. Postoperative pain not only affects patients' rehabilitation and prolongs hospitalization, it can also result in progression from acute to chronic pain, which is the main cause of readmission after day surgery [19].…”

“…Written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at chictr.org.cn (ChiCTR-IOR-16010032, Principal investigator: Qulian Guo, Date of registration: 2016- [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart AngelTM app and an original web platform for patients following outpatient surgery: A prospective observational pilot study.

“…[1][2]. However, safety and adverse events with these procedures remain debated in the literature with regard to potential medical or surgical complications at home [3][4][5][6][7]. Recently, digital technologies have been proposed to remotely monitor outpatients at home and in hospital in order to detect patients with early signs of disease progression or deterioration [8][9][10].…”