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

Distribution of Mangrove Habitats of Grenada and the Grenadines

Mangroves of Grenada and the Grenadines represent significant habitat within the regional context of the Eastern Caribbean. Losses of mangroves through storms, development, and climate change have negative impacts on critical ecosystem services. Estimates of mangrove area exist in the literature but do not fully reflect current conditions, effects of disturbance, and results of recovery; they also do not differentiate these areas by community types. Advances in imagery and remote sensing approaches allow higher-resolution resource mapping. We used remote sensing, image interpretation, and field verification techniques to provide current estimates of the extent and distribution of mangroves. Our results provide the greatest areal total of mangroves to date. Despite loss of mangroves in the recent past, we accounted for approximately 15% more hectares than estimated in the 1990s and 28% more than predicted by hypothetical models for 2005. The discrepancies between prior and current mapped areas are likely due to differences in mapping precision and incomplete surveys that omitted the smaller Grenadine islands but also reflect actual increases in cover from natural recovery and recruitment following historic storm events. Basin mangroves represented the greatest area, while riverine and scrub contributed the least. Fringe mangroves were moderately abundant but were composed of small, isolated patches with high vulnerability to coastal storms and limited opportunity for inland retreat. Documenting the presence and distribution of mangroves, and specifically mangrove community types, will be of value to conservation, restoration, and management planning in light of predicted sea level rise and climate change effects