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

Look up, look out campaign

Look Up, Look Out is a campaign about distracted walking, with a focus on road safety. It is a social movement started by four undergraduates from Nanyang Technological University, Wee Kim Wee School of Communication and Information, with the intention of encouraging youth not to use their mobile devices while crossing the roads. The campaign is the first road safety campaign targeted at pedestrians, where previous efforts on distracted commuting focused mainly on drivers. The campaign targets youth aged 17 to 25, as it was found that young people around this age group had the highest smartphone penetration rates, coupled with the highest weekly instant-message and social networking usage on smartphones. These reasons also influenced the platforms chosen to reach out to them, primarily through social media – Facebook and Instagram. Face-to-face interactions with the target audience were not missed out, with roadshows in schools forming the bulk of our on-ground efforts. This report provides a background to the issue of distracted walking, followed by the group’s primary research involving over 400 youth in the target age group. This research shaped the campaign’s main strategy of “Show, Don’t Tell”, along with the messaging and tactics employed. Successes, challenges, limitations and recommendations are also explored as part of the post-campaign evaluation. This evaluation provides an avenue for discussion, and may form the basis for future projects of the same thread. The appendix at the end of the paper also includes original communication materials, such as documents, collateral and diagrams for reference.Bachelor of Communication Studie