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The recovery care after ambulatory surgery is in a state of flux. There is increasing emphasis on rapid discharge home after ambulatory surgery. Discharge after surgery should be based on clinical criteria rather than based on time. Recent studies suggest that the insistence on oral intake and voiding before discharge is unnecessary and can delay discharge. This article reviews the recent developments in the recovery process after ambulatory surgery.

Numerous studies have reported inadequate pain management after ambulatory surgery. Uncontrolled pain is associated with increased incidence of nausea, anxiety and delirium, prolonged postanesthesia care unit stay, delayed discharge from ambulatory facility, unanticipated hospital admissions and delayed resumption of normal activities. The management of pain after ambulatory surgery poses unique challenges because of the need to balance pain relief with concerns of side effects ans safety. The goal of pain management should be to minimize pain, not only at rest but also during mobilization. Preoperative education of patients regarding the modalities of pain treatment, the pain assessment tools and the degree of pain that they might expect is an important part of pain management. The preemptive and multimodal techniques provide more effective analgersia with reduced incidence of side effects. Local anesthetic techniques should be utilized whenever possible as they are simple, have a high success rate and a low incidence of compilations. Local anesthetic techniques administered before the initiation of the surgery may decrease anesthetic requirements, provide for an earlier recovery and decrease postoperative analgesic requirements. Nonsteroidal antiinflammatory drugs have opioid-sparing effects, which may reduce the incidence of opioid-related side effects. Pain after discharge from the ambulatory facility should be controlled with regular dosing with oral nonsteroidal antiiflammatory drugs and opioid analgesic combination. Oral medications should be administered as early as possible and before the reduction of analgesic effects of parenterally adminisitered drugs. It is important that oral medications are administered at regular intervals rather than on an 'as needed' basis. Regular dosing with pain medications provides superior analgesia as this prevents pain from becoming severe and decreases the incidence of breakthrough pain. Finally, adequate and appropriate application of currently available information and therapies would significantly improve postoperative pain management.

Fast tracking after ambulatory surgery is a new paradigm which involves transferring patients from the operating room to the phase II recovery unit (i.e. bypassing the postanaesthesia care unit). The success of fast tracking depends upon appropriate modification of the anaesthetic technique, which would allow rapid emergence from anaesthesia, and the prevention of common postoperative complications such as pain, nausea and vomiting using a multimodal approach. Implementation of a fast track program involves use of clinical pathways that would reduce hospital stay and ensure patient safety. Finally, the concept of fast tracking should be expanded to the overall postoperative recovery, not just bypassing the postanaesthesia care unit.