The edition · Anaesthesiology
A third of day-case surgery patients had poorly controlled pain in the first week, and a quarter were still limited by it at day 7
The UK POPPY study of recovery after day-case surgery closes the edition. Before it: a new consensus on day surgery, opioid-free esketamine–dexmedetomidine analgesia, the cost of intraoperative handovers, and remote ischaemic preconditioning.
The edition in brief
In POPPY, a national UK prospective study of 7,839 day-case surgery patients, 33.5% had a poor pain outcome (pain above 4/10) in the first week and 26.3% still had pain limiting function on day 7. Chronic pain, frailty, treatment for anxiety or depression, larger operations, head and neck and orthopaedic surgery were associated with worse outcomes; opioid-naive patients did better. Recovery at home is less complete than same-day discharge implies, and the at-risk group is identifiable before surgery. A UK consensus from the Association of Anaesthetists and partner societies sets out recommendations on day surgery selection, comorbidities including frailty, obesity and sleep apnoea, anaesthetic technique and discharge. In a 132-patient Chinese trial after gynaecological laparoscopy, patient-controlled esketamine with dexmedetomidine was non-inferior to sufentanil for pain on coughing and improved quality of recovery (QoR-15 116 vs 108). In 145,383 US patients, a handover between attending anaesthetists during surgery was associated with slightly longer stay and more 30-day readmissions (14.0% vs 12.3%; adjusted RR 1.06), more so at night. A meta-analysis of 79 trials found remote ischaemic preconditioning did not reduce mortality after non-cardiac surgery (OR 0.79, 0.51–1.24). The pearl: start regular oral analgesia before a nerve block wears off.
A UK consensus sets the standard for selecting and managing patients for day surgery
Write or update your unit's day-surgery selection and discharge criteria against this consensus, judging comorbidities by optimisation rather than excluding them outright.
Opioid-free esketamine–dexmedetomidine analgesia matched sufentanil for pain and improved recovery
After laparoscopic gynaecological surgery, an esketamine–dexmedetomidine infusion is a reasonable opioid-free option where available, with monitoring for sedation.
Handing over an anaesthetic mid-case was associated with slightly longer stays and more readmissions
Use a structured checklist for every intraoperative anaesthesia handover, especially in major cases and late in the day.
Remote ischaemic preconditioning did not reduce mortality after non-cardiac surgery
Do not use remote ischaemic preconditioning routinely in non-cardiac surgery; the mortality benefit was not shown.
Start oral analgesia before the nerve block wears off
Give block patients regular analgesia from day zero and tell them to dose before the block wears off, not after the pain starts.
One in three day-case patients had poor pain control in the first week — and the at-risk group is predictable
Flag day-case patients with chronic pain, opioid use, frailty or mood disorder at pre-assessment, and give them a written analgesia plan and follow-up calls in the first week.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free