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

Ravi Sundaram, Pirate Modernity: Delhi’s Media Urbanism

The field of urban studies is a growing one as Indian cities transform beyond recognition. In his book Pirate Modernity: Delhi’s Media Urbanism, Ravi Sundaram tries to capture this transformation, using a theoretical lens little explored in existing literature. To wit, Sundaram is interested in ‘the evaporation of the boundary between technology and urban life’ which has produced ‘a delirious disorientation of the senses’ (p. 7). The examples of such evaporation and of a newly technologized u..

Remaking urban worlds : New Delhi in the time of economic liberalization

textThis dissertation examines the impact of neoliberal economic reform on New Delhi's urban landscape. It shows how the city has transformed since 1991 through two distinct, but interlinked processes: firstly massive 'upgradation' and place-marketing efforts, initiated and supported by the state, to create for the city a global identity worthy of the capital of a newly resurgent and aspirational nation, one that is also welcoming to new capital flows and forms as Delhi undergoes massive spatial, and economic expansion. Secondly, neoliberal urban development is also marked by a series of mass evictions of the city's existing informal, indigenous economy as degraded urban forms. In tracking the unfolding 'worlding' of the city, the dissertation is interested in the production of locality at the scale of the city, the ways by different sites, networks and neighborhoods articulate with the process, and how locality is produced through a series of inclusions and exclusions. In the first half of the dissertation, the focus is the conjectural emergence of conditions of transformation, mainly through the articulation of state urban renewal policies which promote privatized urban development, judicial eviction orders and media circulated calls for the building of a new 'upgraded' city to replace the old. This, as a new 'globalized' and aestheticized imaginary of the nation, city and its citizens takes shape. In the second half, the dissertation examines shows how upgradation and mass eviction have played out in Delhi neighborhoods, juxtaposing the experience of middle class areas, who's activism has been vital in putting forth a new vision of the city, with two cases of displacement. These are the demolition of the city's slums, and secondly the sealing or closure of large networks of indigenous/informal traders. In all three cases, the dissertation outlines ethnographically how residents receive, perceive and negotiate changes in relation to their memories, habitus, and local knowledges of the old, and how they engage with state and political actors, judicial fiat, party politics and the structures of the city's mass democracy to encourage or oppose urban reforms. In its conclusion, it argues that upgradation and eviction notwithstanding, activism across classes has engendered a common critique of governance among residents.Anthropolog