Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Risk Factors of Early Childhood Caries Among Preschool Children in Eastern Saudi Arabia

This study aimed to determine the risk factors of early childhood caries (ECC) among preschool children from eastern Saudi Arabia. In this cross-sectional study, 241 carers and their children from 10 daycares were recruited and asked to complete a questionnaire aimed at assessing their sociodemographic profile and oral health-related behaviors. This was followed by a dental examination of the children by two calibrated dentists. Caries status was recorded using the dmft index. Chi-square and logistic regression tests were used to analyze the data ( p &lt; 0.05). The mean dmft of the children was 4.39 (SD ± 4.25). According to logistic regression analysis, children who were bottle-fed between 7 and 12 months (Adjusted Odds Ratio (AOR): 0.110) or breastfed between 13 and 18 months (AOR: 0.028) were less likely to have ECC than those with a prolonged feeding duration (&gt;18 months). Also, those with smoking carers (AOR: 0.176) were less likely to have ECC than those with nonsmoking carers. On the other hand, children who had working carers, mainly mothers, in the education sector (AOR: 11.105), were more likely to have ECC ( p &lt; 0.05). The risk factors associated with the presence of ECC among preschool children in eastern Saudi Arabia include the mother’s occupation and the carer’s smoking status, as well as feeding practices (particularly bottle feeding). These factors can be modified by encouraging carers to completely wean their children (particularly from the bottle) by 18 months of age and advising working mothers to perform tooth brushing for their children in the morning before they go to work and in the evening before the children go to bed. </jats:p