After an office-based procedure, it is expected that the patient will be able to sit in a chair or ambulate to an examination room to dress almost immediately. A formal PACU may not be present, and the patient may recover in the surgical suite. Regardless of where the patient recovers, it is important to adhere to all ASA standards for monitoring and documentation throughout the postoperative period. Problems of postoperative nausea and vomiting (PONV) and pain may become particularly troublesome. It is imperative that every anesthetic administered is designed to maximize patient alertness and mobility and minimize the risks of the need for a prolonged PACU stay.
- Pain Management. Local anesthesia and conscious sedation supplemented by wound infiltration with local anesthetics or nerve blocks often form the basis for a multimodal strategy for postoperative pain management. Nonopioid analgesics (acetaminophen) and nonsteroidal anti-inflammatory drugs (ketorolac) are routinely used. To minimize the potential for postoperative bleeding and risk of gastrointestinal complications, more specific cyclooxygenase-2 inhibitors are being increasingly used as nonopioid adjuvants for minimizing postoperative pain.
- Postoperative Nausea and Vomiting. An optimal antiemetic regimen for OBA has yet to be established, but because the causes of PONV are multifactorial, combination therapies may be more beneficial in high-risk patients. Many of the traditional first-line therapies are associated with sedation. Serotonin receptor antagonists and dexamethasone may be valuable.