Analgesic side effects and minor surgery: which analgesic for minor and day-case surgery?

A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. Less than 50% of the orthopaedic patients in these groups required any postoperative analgesia. However, there was a high incidence of vomiting (40%) in those receiving an opioid during operation, associated with overnight admission in more than 50% of those who vomited. In the patients undergoing oral surgery, ibuprofen administered before operation significantly reduced analgesic requirement, without unwanted side effects. The use of codeine-paracetamol or a non-steroidal anti-inflammatory agent before body surface surgery appeared to be advantageous in reducing postoperative analgesic needs, without causing problems associated with the stronger opioids.