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

Abstracts from the 20th International Symposium on Signal Transduction at the Blood-Brain Barriers

https://deepblue.lib.umich.edu/bitstream/2027.42/138963/1/12987_2017_Article_71.pd

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

An overlooked cause of retrosternal pain: Tetracycline-induced esophagitis

Chest pain is one of the most common admission symptoms of emergency services. The differential diagnosis is usually challenging but also very important for emergency physicians. After the exclusion of cardiac sources; noncardiac etiologies must be evaluated. Herein, we report a remarkable case who referred to our emergency department with chest pain and eventually diagnosed as tetracycline-induced esophagitis. Pill esophagitis should be kept in mind in the differential diagnosis of noncardiac chest pain. [Med-Science 2018; 7(2.000): 451-2

Successful Evaluation of Biphasic T-wave of Wellens Syndrome in the Emergency Department

INTRODUCTION: Wellens Syndrome (WS) is a condition characterized by typical changes in ECG, which are biphasic T-wave inversions (less common) or symmetric and deeply inverted T waves (including 75%) in lead V(2)–V(3) chest derivations. WS is considered important because it has not only diagnostic value but also prognostic value. CASE REPORT: A 52-year-old male patient without cardiovascular disease or risk factors was admitted to the emergency department (ED) suffering with chest pain and syncope, just after having been involved in a discussion at work. Chest pain was radiating to the left arm and was not precipitated by exertion. Shortness of breath was not accompanied by angina. The patient underwent cardiac catheterization at Department of Cardiology. Stents were positioned in both LADA and a severe lesion in the left main coronary artery. The patient was discharged two days following catheterization, due to no chest pain and hemodynamic instability during the hospitalization. The patient has approved the inform consent for to be used for this case report

Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis

Conclusion: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients

Successful Evaluation of Biphasic T-wave of Wellens Syndrome in the Emergency Department

INTRODUCTION: Wellens Syndrome (WS) is a condition characterized by typical changes in ECG, which are biphasic T-wave inversions (less common) or symmetric and deeply inverted T waves (including 75%) in lead V(2)–V(3) chest derivations. WS is considered important because it has not only diagnostic value but also prognostic value. CASE REPORT: A 52-year-old male patient without cardiovascular disease or risk factors was admitted to the emergency department (ED) suffering with chest pain and syncope, just after having been involved in a discussion at work. Chest pain was radiating to the left arm and was not precipitated by exertion. Shortness of breath was not accompanied by angina. The patient underwent cardiac catheterization at Department of Cardiology. Stents were positioned in both LADA and a severe lesion in the left main coronary artery. The patient was discharged two days following catheterization, due to no chest pain and hemodynamic instability during the hospitalization. The patient has approved the inform consent for to be used for this case report