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 Alendronate in Male Osteoporosis

Osteoporosis in men is increasingly recognized as an important public health issue because of mortality and disability. Approximately 25-30% of all hip fractures occur in men and men are over 3 times more likely to die following a hip fracture than women. Nowadays, the importance of treatment in male osteoporosis is increasing. The aim of this study was to evaluate the effect of alendronate treatment on idiopathic male osteoporosis. Thirty-one male patients with idiopathic osteoporosis were enrolled in the study. The mean age was 63,32±10,26 . All patients were treated with Alendronate 10 mgr/daily and calcium 500 mgr/daily. Bone mineral density (BMD) was measured at baseline and at 1 and 2 years by using Dual Energy X Ray Absorbtiometry at the lumbar spine(L1-4 ) and proximal femur. There was a significant increase from baseline at lumbar spine and femoral BMD after 1 year and 2 years (p< 0,01). Lumbar spine BMD increased by 6% and 11% after 1 and 2 years respectively. Total femur BMD increased by 2.9% after 1 year and 5.1% after 2 years. No significant side effects occured during the study. In summary, alendronate increased lumbar spine and femoral bone mineral density, and was found to be an effective and well-tolerated drug in men with idiopathic osteoporosis

The relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy

Objectives: The aim of this study was to investigate the relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy (DMD)

Awereness and knowledge level of osteoporosis in patients with neuromuscular diseases- multicentre study

Objective: To evaluate the awareness and knowledge level of osteoporosis in patients with neuromuscular diseases (NMDs) and to investigate the associated factors