Some interventions may be effective but the size of the effect or the complication of undertaking them confers no measurable benefit over conventional methods. Diclofenac and ibuprofen at standard doses give analgesia equivalent to that obtained with 10 mg of intramuscular morphine. The relative effectiveness of these analgesics is compared in an effectiveness 'ladder' which can inform prescribers making choices for individual patients, or planning day-case surgery. Dose-response relationships show that higher doses of ibuprofen may be particularly effective. Postoperative nausea and vomiting The proportion of patients who may feel nauseated or vomit after surgery is very variable, despite similar operations and anaesthetic techniques.
Systematic review can still lead to clear estimations of effectiveness of interventions.
This report has focused on two elements of day-case care. It is clear that the economics of day-case work require that the vast majority of patients are fit to go home and that, once home, they do not have to return to hospital or seek advice from the primary care team. To date, audits at local level have identified both pain and nausea and vomiting as problems. Providing adequate analgesia may be easier than guaranteeing minimal nausea and vomiting. The package of care in day-case surgery needs to be revisited regularly lest surgical interventions are the cause of increased hospitalisation and returns.