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

Cutaneous drain opener burns: Report from a tertiary care burns unit

Background: Chemical burn injuries are generally industrial, but it can happen at home. Drain opener is one of the common causes of this type of burns. Drain openers are available in powder and liquid forms and contain either sodium hydroxide or sulfuric acid which causes burns when it gets in contact with the skin. This article reviews drain opener burns which presented to a tertiary care burns unit. Methods: A retrospective study of all drain opener chemical burns which presented to Khoula hospital, Muscat, Oman between 01.01.2013 and 31.12.2017. Results: There were 126 cases of drain opener burns (56% of all chemical burns). 80% of the patients were males. The mean age was 29.6 years. 18% of the patients were children. 93% of the patients had 10% or less of total body surface area (TBSA) affected. Upper limb was most commonly involved followed by lower limb and head and neck area. 37.3% of the patients had superficial dermal burns, 29.4% had mixed superficial and deep dermal burns and 33.3% had deep dermal or full thickness burns. There was no systemic poisoning in any of the cases. One of the patients required escharotomy. Two patients required ventilation. 60% of the patients had first aid given at the time of injury. Washing with tap water was the first aid given for all patients. 38% of the patients required surgery. 38% of the patients had hypertrophic scarring, 14% had hyperpigmented scars and 5% developed contracture. There were no mortalities. Conclusion: Drain openers are a common cause of domestic chemical burns in our community. These burns do not usually involve a very large area but can cause significant morbidity. The injury keeps happening despite warning signs on the bottles and the care taken by the users. More awareness needs to be created and clear warning signs must be kept on the bottles in order to reduce this type of injury. Keywords: Drain, Alkali, Acid, Burns, Chemica