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.