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

صياغة هاملتون الامامية و تكامل المسار لفعل بوليكوف داي برين ثابت المقياس

We have studied the instant form quantization and light front quantization of conformally gauge fixed polyakov D1 brane action with and without scalar dilation field and showed these theories when consider in the presence of background gauge fields such as the 2- form gauge field Bαβ(σ,τ) or in the presence of U(1) gauge field Aα(σ,τ) and constant scalar axion field C(σ,τ). The instant form quantization is studied in the equal world sheet time framework on hyperplanes defined by world σ o = τ = constant and light front quantization in equal light cone world sheet time framework in hyperplane defined by σ + = (τ+ σ) = constant. TheHamiltonformulation is given by two approaches: The first is Dirac approach while the second is Güler approach. The equal equations of motion are obtained as total differential equations in many variables. These equations of motion are in exact agreement with those equations that had been obtained using Dirac's method