Skip to main content

Advertisement

SpringerLink
Log in

Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers

  • Other Pain (N Vadivelu and AD Kaye, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

With the widespread growth of ambulatory surgery centers (ASCs), the number and diversity of operations performed in the outpatient setting continue to increase. In parallel, there is an increase in the proportion of patients with a history of chronic opioid use and misuse undergoing elective surgery. Patients with such opioid tolerance present a unique challenge in the ambulatory setting, given their increased requirement for postoperative opioids. Guidelines for managing perioperative pain, anticipating postoperative opioid requirements and a discharge plan to wean off of opioids, are therefore needed.

Recent Findings

Expert guidelines suggest using multimodal analgesia including non-opioid analgesics and regional/neuraxial anesthesia whenever possible. However, there exists variability in care, resulting in challenges in perioperative pain management. In a recent study of same-day admission patients, anesthesiologists correctly identified most opioid-tolerant patients, but used non-opioid analgesics only half the time. The concept of a focused ambulatory pain specialist on site at each ASC has been suggested, who in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized.

Summary

This review focuses on perioperative pain management in three subsets of patients who exhibit opioid tolerance: those on large doses of opioids (including abuse-deterrent formulations) for chronic non-malignant or malignant pain; those who have ongoing opioid misuse; and those who were prior addicts and are now on methadone/suboxone maintenance. We also discuss perioperative pain management for patients who have implanted devices such as spinal cord stimulators and intrathecal pain pumps.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Steiner CA, Karaca Z, Moore BJ, Imshaug MC, Pickens G. STATISTICAL BRIEF# 223. 2017.

  2. MedPAC. Medicare Payment Policy. 2013.

  3. Bian J, Morrisey MA. Free-standing ambulatory surgery centers and hospital surgery volume. Inquiry. 2007;44(2):200–10. https://doi.org/10.5034/inquiryjrnl_44.2.200.

    Article  PubMed  Google Scholar 

  4. Lynk WJ, Longley CS. The effect of physician-owned surgicenters on hospital outpatient surgery. Health Aff (Millwood). 2002;21(4):215–21. https://doi.org/10.1377/hlthaff.21.4.215.

    Article  Google Scholar 

  5. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85(4):808–16. https://doi.org/10.1097/00000539-199710000-00017.

    Article  CAS  PubMed  Google Scholar 

  6. General OoI. Quality oversight of ambulatory surgery centers: a system in neglect. In: Department of Health and Human Services Report OEI-01-00-0450 2002. Available at http://oig.hhs.gov/oei/reports/oei-01-00-00450.pdf. Accessed July 2019.

  7. Schaefer MK, Jhung M, Dahl M, Schillie S, Simpson C, Llata E, et al. Infection control assessment of ambulatory surgical centers. JAMA. 2010;303(22):2273–9. https://doi.org/10.1001/jama.2010.744.

    Article  CAS  PubMed  Google Scholar 

  8. Services. CfMaM. Report to Congress: Medicare Ambulatory Surgery Center Value-Based Purchasing Implementation Plan. 2010.

  9. Association. ASC. Ambulatory surgery centers: a positive trend in health care. ASCA: Ambulatory Surgery Center Association website. 2012.

  10. Wilson JL, Poulin PA, Sikorski R, Nathan HJ, Taljaard M, Smyth C. Opioid use among same-day surgery patients: prevalence, management and outcomes. Pain Res Manag. 2015;20(6). https://doi.org/10.1155/2015/897491.

  11. Lee D, Armaghani S, Archer KR, Bible J, Shau D, Kay H, et al. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am. 2014;96(11):e89. https://doi.org/10.2106/jbjs.m.00865.

    Article  PubMed  Google Scholar 

  12. Lawrence JT, London N, Bohlman HH, Chin KR. Preoperative narcotic use as a predictor of clinical outcome: results following anterior cervical arthrodesis. Spine (Phila Pa 1976). 2008;33(19):2074–8. https://doi.org/10.1097/BRS.0b013e3181809f07.

    Article  Google Scholar 

  13. Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L, et al. Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine (Phila Pa 1976). 2006;31(18):E648–63. https://doi.org/10.1097/01.brs.0000231727.88477.da.

    Article  Google Scholar 

  14. Meridy HW. Criteria for selection of ambulatory surgical patients and guidelines for anesthetic management: a retrospective study of 1553 cases. Anesth Analg. 1982;61(11):921–6.

    Article  CAS  Google Scholar 

  15. Chung F. Recovery pattern and home-readiness after ambulatory surgery. Anesth Analg. 1995;80(5):896–902. https://doi.org/10.1097/00000539-199505000-00008.

    Article  CAS  PubMed  Google Scholar 

  16. Ghosh S, Sallam S. Patient satisfaction and postoperative demands on hospital and community services after day surgery. Br J Surg. 1994;81(11):1635–8. https://doi.org/10.1002/bjs.1800811124.

    Article  CAS  PubMed  Google Scholar 

  17. Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA. 1989;262(21):3008–10.

    Article  CAS  Google Scholar 

  18. Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery--a prospective study. Can J Anaesth. 1998;45(7):612–9. https://doi.org/10.1007/BF03012088.

    Article  CAS  PubMed  Google Scholar 

  19. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015;16(8):769–80. https://doi.org/10.1016/j.jpain.2015.05.002.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Laxmaiah Manchikanti M, Bert Fellows M, Hary Ailinani M. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician. 2010;13:401–35.

    PubMed  Google Scholar 

  21. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22(1):62–8. https://doi.org/10.3122/jabfm.2009.01.080102.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Caudill-Slosberg MA, Schwartz LM, Woloshin S. Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000. Pain. 2004;109(3):514–9. https://doi.org/10.1016/j.pain.2004.03.006.

    Article  PubMed  Google Scholar 

  23. Martell BA, O’Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146(2):116–27. https://doi.org/10.7326/0003-4819-146-2-200701160-00006.

    Article  PubMed  Google Scholar 

  24. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010;1:CD006605. https://doi.org/10.1002/14651858.CD006605.pub2.

    Article  Google Scholar 

  25. CDC/NCHS. National vital statistics system, mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC. 2017. https://wonder.cdc.gov. Accessed July 2019.

  26. Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(7):958–68. https://doi.org/10.1001/jamainternmed.2016.1251.

    Article  CAS  PubMed  Google Scholar 

  27. Trescot AM, Boswell MV, Atluri SL, Hansen HC, Deer TR, Abdi S, et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician. 2006;9(1):1–39.

    PubMed  Google Scholar 

  28. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16(2):137–62. https://doi.org/10.1016/j.joca.2007.12.013.

    Article  CAS  Google Scholar 

  29. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–6. https://doi.org/10.1097/mlr.0000000000000625.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hale ME, Moe D, Bond M, Gasior M, Malamut R. Abuse-deterrent formulations of prescription opioid analgesics in the management of chronic noncancer pain. Pain Manag. 2016;6(5):497–508. https://doi.org/10.2217/pmt-2015-0005.

    Article  PubMed  Google Scholar 

  31. Vadivelu N, Schermer E, Kodumudi G, Berger JM. The clinical applications of extended-release abuse-deterrent opioids. CNS Drugs. 2016;30(7):637–46.

    Article  CAS  Google Scholar 

  32. Mastropietro DJ, Omidian H. Abuse-deterrent formulations: part 2: commercial products and proprietary technologies. Expert Opin Pharmacother. 2015;16(3):305–23. https://doi.org/10.1517/14656566.2014.970175. Gives in depth knowledge into various abuse-deterrent formulations and summarize perioperative management of patients on such formulations.

  33. Gasior M, Bond M, Malamut R. Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations. Postgrad Med. 2016;128(1):85–96. https://doi.org/10.1080/00325481.2016.1120642.

    Article  PubMed  Google Scholar 

  34. Bulloch M. Abuse-deterrent opioids: a primer for pharmacists. Pharm Times. 2015. https://www.pharmacytimes.com/contributor/marilynbulloch-pharmd-bcps/2015/10/abuse-deterrent-opioids-a-primer-for-pharmacists.

  35. Burness CB, Keating GM. Oxycodone/naloxone prolonged-release: a review of its use in the management of chronic pain while counteracting opioid-induced constipation. Drugs. 2014;74(3):353–75.

    Article  CAS  Google Scholar 

  36. Badalamenti VC, Buckley JW, Smith ET. Safety of EMBEda (morphine sulfate and naltrexone hydrochloride) extended-release capsules: review of postmarketing adverse events during the first year. J Opioid Manag. 2012;8(2):115–25.

    Article  Google Scholar 

  37. Vadivelu N, Mitra S, Kaye AD, Urman RD. Perioperative analgesia and challenges in the drug-addicted and drug-dependent patient. Best Pract Res Clin Anaesthesiol. 2014;28(1):91–101. https://doi.org/10.1016/j.bpa.2014.02.003.

    Article  PubMed  Google Scholar 

  38. Hord A, Sinatra R, Yearbook mSLM. Postoperative analgesia in the opioid-dependent patient. Acute Pain: Mechanisms & Management, Mosby-Year Book. 1992. https://books.google.com/books?id=AzM5wQEACAAJ.

  39. Jage J, Bey T. Postoperative analgesia in patients with substance use disorders: part I. Acute Pain. 2000;3(3):29–44.

    Article  Google Scholar 

  40. May JA, White HC, Leonard-White A, Warltier DC, Pagel PS. The patient recovering from alcohol or drug addiction: special issues for the anesthesiologist. Anesth Analg. 2001;92(6):1601–8. https://doi.org/10.1097/00000539-200106000-00050.

    Article  CAS  PubMed  Google Scholar 

  41. Pasero C, Compton P. Pain management in addicted patients. Am J Nurs. 1997;4:17–9.

    Google Scholar 

  42. Rapp SE, Ready LB, Nessly ML. Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review. Pain. 1995;61(2):195–201. https://doi.org/10.1016/0304-3959(94)00168-e.

    Article  PubMed  Google Scholar 

  43. Twycross RG. Choice of strong analgesic in terminal cancer: diamorphine or morphine? Pain. 1977;3(2):93–104. https://doi.org/10.1016/0304-3959(77)90072-0.

    Article  CAS  PubMed  Google Scholar 

  44. Vadivelu N, Kai AM, Kodumudi V, Berger JM. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting. J Pain Res. 2016;9:425–35. https://doi.org/10.2147/JPR.S86579.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology. 2004;101(1):212–27. https://doi.org/10.1097/00000542-200407000-00032.

    Article  PubMed  Google Scholar 

  46. Frölich M, Giannotti A, Modell JH. Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg. 2001;93(3):647–8.

    Article  Google Scholar 

  47. Sevarino F, Ning T, Sinatra R, Hord A, Ginsberg B, Preble L, et al. Transdermal fentanyl for acute pain management. Acute Pain: Mechanisms & Management, Mosby-Year Book. 1992;364–9. https://books.google.com/books?id=AzM5wQEACAAJ.

  48. Caplan R, Ready L, Oden R, FJJ M 3rd, Nessly ML, Olsson GL. Transdermal fentanyl for postoperative pain management. A double-blind placebo study. JAMA. 1989;261:1036–9.

    Article  CAS  Google Scholar 

  49. Rubenstein RB, Spira I, Wolff WI. Management of surgical problems in patients on methadone maintenance. Am J Surg. 1976;131(5):566–9. https://doi.org/10.1016/0002-9610(76)90013-1.

    Article  CAS  PubMed  Google Scholar 

  50. Compton P, Charuvastra VC, Kintaudi K, Ling W. Pain responses in methadone-maintained opioid abusers. J Pain Symptom Manag. 2000;20(4):237–45. https://doi.org/10.1016/s0885-3924(00)00191-3.

    Article  CAS  Google Scholar 

  51. Moorman-Li R, Motycka CA, Inge LD, Congdon JM, Hobson S, Pokropski B. A review of abuse-deterrent opioids for chronic nonmalignant pain. P T. 2012;37(7):412–8.

    PubMed  PubMed Central  Google Scholar 

  52. Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144(2):127–34. https://doi.org/10.7326/0003-4819-144-2-200601170-00010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Roberts DM, Meyer-Witting M. High-dose buprenorphine: perioperative precautions and management strategies. Anaesth Intensive Care. 2005;33(1):17–25. https://doi.org/10.1177/0310057X0503300104.

    Article  CAS  PubMed  Google Scholar 

  54. USPSTF TF. Intrathecal therapy for cancer and non-cancer pain. Pain Physician. 2011;14:219–48.

    Google Scholar 

  55. Gomar C, Carrero EJ. Delayed arousal after general anesthesia associated with baclofen. Anesthesiology. 1994;81(5):1306–7. https://doi.org/10.1097/00000542-199411000-00035.

    Article  CAS  PubMed  Google Scholar 

  56. Deer TR. Current and future trends in spinal cord stimulation for chronic pain. Curr Pain Headache Rep. 2001;5(6):503–9.

    Article  CAS  Google Scholar 

  57. Reig E, Abejón D. Spinal cord stimulation: a 20-year retrospective analysis in 260 patients. Neuromodulation. 2009;12(3):232–9.

    Article  Google Scholar 

  58. Harned ME, Gish B, Zuelzer A, Grider JS. Anesthetic considerations and perioperative management of spinal cord stimulators: literature review and initial recommendations. Pain Physician. 2017;20(4):319–29. Given the dearth of literature in the subject of managing patients with indwelling spinal cord stimulators and intrathecal pumps, this reference has been given major importance in this review.

  59. Carroll IR, Angst MS, Clark JD. Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med. 2004;29(6):576–91.

    Article  Google Scholar 

  60. Vadivelu N, Chang D, Lumermann L, Suchy T, Burg MM, Fontes ML. Management of patients on abuse-deterrent opioids in the ambulatory surgery setting. Curr Pain Headache Rep. 2017;21(2):10. https://doi.org/10.1007/s11916-017-0612-1. Gives in depth knowledge into various abuse-deterrent formulations and summarize perioperative management of patients on such formulations.

  61. Ghisi D, Bonarelli S. Ambulatory surgery with chloroprocaine spinal anesthesia: a review. Ambul Anesth. 2015;2:111–20.

    Google Scholar 

  62. Alley EA, Mulory MF. Neuraxial anesthesia for outpatients. Anesthesiol Clin. 2014;32(2):357–69. https://doi.org/10.1016/j.anclin.2014.02.007.

    Article  PubMed  Google Scholar 

  63. Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology. 2002;97(2):315–9.

    Article  Google Scholar 

  64. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101(6):1634–42. https://doi.org/10.1213/01.ANE.0000180829.70036.4F.

    Article  PubMed  Google Scholar 

  65. Förster JG. Short-acting spinal anesthesia in the ambulatory setting. Curr Opin Anaesthesiol. 2014;27(6):597–604.

    Article  Google Scholar 

  66. Förster J, Kallio H, Rosenberg P, Harilainen A, Sandelin J, Pitkänen M. Chloroprocaine vs. articaine as spinal anaesthetics for day-case knee arthroscopy. Acta Anaesthesiol Scand. 2011;55(3):273–81.

    Article  Google Scholar 

  67. Reuben SS, Connelly NR. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg. 2000;91(5):1221–5. https://doi.org/10.1097/00000539-200011000-00032.

    Article  CAS  PubMed  Google Scholar 

  68. Katz WA. Cyclooxygenase-2-selective inhibitors in the management of acute and perioperative pain. Cleve Clin J Med. 2002;69 Suppl 1(1):SI65–75. https://doi.org/10.3949/ccjm.69.suppl_1.si65.

    Article  PubMed  Google Scholar 

  69. Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Med. 2015;16(2):383–403. https://doi.org/10.1111/pme.12619.

    Article  PubMed  Google Scholar 

  70. Guignard B, Coste C, Costes H, Sessler DI, Lebrault C, Morris W, et al. Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. Anesth Analg. 2002;95(1):103–8, table of contents. https://doi.org/10.1097/00000539-200207000-00018.

    Article  CAS  PubMed  Google Scholar 

  71. Parikh B, Maliwad J, Shah VR. Preventive analgesia: effect of small dose of ketamine on morphine requirement after renal surgery. J Anaesthesiol Clin Pharmacol. 2011;27(4):485–8. https://doi.org/10.4103/0970-9185.86592.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Kararmaz A, Kaya S, Karaman H, Turhanoglu S, Ozyilmaz MA. Intraoperative intravenous ketamine in combination with epidural analgesia: postoperative analgesia after renal surgery. Anesth Analg. 2003;97(4):1092–6, table of contents. https://doi.org/10.1213/01.ane.0000080205.24285.36.

    Article  CAS  PubMed  Google Scholar 

  73. Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–46. https://doi.org/10.1097/ALN.0b013e3181e90914.

    Article  CAS  PubMed  Google Scholar 

  74. Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J. 2008;4(1):62–5. https://doi.org/10.1007/s11420-007-9069-9.

    Article  PubMed  Google Scholar 

  75. Subramaniam K, Akhouri V, Glazer PA, Rachlin J, Kunze L, Cronin M, et al. Intra- and postoperative very low dose intravenous ketamine infusion does not increase pain relief after major spine surgery in patients with preoperative narcotic analgesic intake. Pain Med. 2011;12(8):1276–83. https://doi.org/10.1111/j.1526-4637.2011.01144.x.

    Article  PubMed  Google Scholar 

  76. Barreveld AM, Correll DJ, Liu X, Max B, McGowan JA, Shovel L, et al. Ketamine decreases postoperative pain scores in patients taking opioids for chronic pain: results of a prospective, randomized, double-blind study. Pain Med. 2013;14(6):925–34. https://doi.org/10.1111/pme.12086.

    Article  PubMed  Google Scholar 

  77. Menigaux C, Guignard B, Fletcher D, Sessler DI, Dupont X, Chauvin M. Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy. Anesth Analg. 2001;93(3):606–12. https://doi.org/10.1097/00000539-200109000-00016.

    Article  CAS  PubMed  Google Scholar 

  78. Schotola H, Kirsch KC, Hocker J, Egan M, Buttner B, Wiese C, et al. Ketamine in outpatient arthroscopic shoulder surgery: effects on postoperative pain, hemodynamic stability and process times. Open Med (Wars). 2015;10(1):297–305. https://doi.org/10.1515/med-2015-0043.

    Article  CAS  Google Scholar 

  79. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011;58(10):911–23. https://doi.org/10.1007/s12630-011-9560-0.

    Article  PubMed  Google Scholar 

  80. Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005;102(1):211–20. https://doi.org/10.1097/00000542-200501000-00030.

    Article  PubMed  Google Scholar 

  81. Gorlin AW, Rosenfeld DM, Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia. J Anaesthesiol Clin Pharmacol. 2016;32(2):160–7. https://doi.org/10.4103/0970-9185.182085.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Adam C, Young M, Jaycox MP, Lubenow TR. Perioperative management of patients with intrathecal drug delivery systems. Am Soc Reg Anesth Pain Med. https://www.asra.com/page/226/perioperative-management-of-patients-with-intrathecal-drug-delivery-systems. Accessed July 2019. Given the dearth of literature in the subject of managing patients with indwelling spinal cord stimulators and intrathecal pumps, this reference has been given major importance in this review.

  83. Walsh KM, Machado AG, Krishnaney AA. Spinal cord stimulation: a review of the safety literature and proposal for perioperative evaluation and management. Spine J. 2015;15(8):1864–9. https://doi.org/10.1016/j.spinee.2015.04.043.

    Article  PubMed  Google Scholar 

  84. Patel S, Das S, Stedman RB. Urgent cesarean section in a patient with a spinal cord stimulator: implications for surgery and anesthesia. Ochsner J. 2014;14(1):131–4.

    PubMed  PubMed Central  Google Scholar 

  85. Bernardini DJ, Pratt SD, Takoudes TC, Simopoulos TT. Spinal cord stimulation and the pregnant patient-specific considerations for management: a case series and review of the literature. Neuromodulation. 2010;13(4):270–4. https://doi.org/10.1111/j.1525-1403.2010.00288.x.

    Article  PubMed  Google Scholar 

  86. Nadherny W, Anderson B, Abd-Elsayed A. Perioperative and periprocedural care of patients with intrathecal pump therapy. Neuromodulation. 2018;22:775–80. https://doi.org/10.1111/ner.12880.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, New Haven, CT, USA

    Kanishka Rajput & Nalini Vadivelu

  2. New Haven, CT, USA

    Kanishka Rajput

Authors
  1. Kanishka Rajput
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nalini Vadivelu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kanishka Rajput.

Ethics declarations

Conflict of Interest

Kanishka Rajput and Nalini Vadivelu declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Other Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rajput, K., Vadivelu, N. Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers. Curr Pain Headache Rep 25, 1 (2021). https://doi.org/10.1007/s11916-020-00922-3

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11916-020-00922-3

Keywords

Search

Navigation