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

The effect of norepinephrine versus dopamine in renal transplant recipients on postoperative graft function

Finding the ideal vasopressor for use during the crucial phase of graft anastomosis is still an ongoing search to improve graft function in recipients of renal transplants. This study aimed to compare the effect of norepinephrine versus dopamine on renal graft function and postoperative serum creatinine. A randomized single-blind clinical trial of 44 patients was divided into two equal groups. Group N: norepinephrine infusion was used at a starting dose of 0.05μg/kg/min with dose range: 0.05–0.15 μ/kg/min and group D; dopamine infusion was used at a starting dose of 5μg/kg/min with dose range: 5–15 μ/kg/min. Postoperative serum creatinine and renal doppler resistive index, were compared between the two groups. There were significant differences within and between both groups over time regarding postoperative serum creatinine levels (group D, P-value Norepinephrine and dopamine have comparable effects on graft function in the renal recipient patients.</p