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

Global vitamin D status and determinants of hypovitaminosis D

The aim of the study was to compare the structural and functional parameters of the myocardium in different genotypes of polymorphic markers BsmI (B/b) (rs1544410) and FokI (F/f) (rs2228570) of the vitamin D receptor gene (VDR) in individuals with cardiovascular diseases (CVD). Materials and Methods. We examined 198 patients with CVD. BsmI and FokI of the VDR gene were determined by the polymerase chain reaction. The blood levels of parathyroid hormone, 25(OH)D total, endothelin-1, plasma renin activity were revealed by the method of enzyme immunoassay. The calcium and phosphorus level in the blood was defined by the colorimetric method. Echocardiography was performed by GE Logic P5 Premium (Korea) with a phased sector sensor with a frequency of 2–4 MHz in the modes M-, B-, PW, CW. Results. All participants were divided into groups according to genotypes of FokI and BsmI of the VDR gene. For each polymorphism, the groups were comparable in age, CVD, blood pressure, heart rate, body mass index and levels of the estimated biomarkers. Significant differences (p < 0.05) in the sizes of the aorta and the left atrium (LA), in the sizes and volumes of the left ventricle (LV) and its walls, the diameter of the LV outlet tract and the ejection fraction between the groups with the genotypes of FF and ff were established. In addition, differences (p < 0.05) were found in the aorta size, LA and interventricular septum between the groups with the genotypes of ff and Ff. According to the genotypes of BsmI of the VDR gene, the groups did not differ significantly in the estimated structural and functional parameters of the myocardium and aorta. Hypertrophy of the LV is diagnosed in 78.6 % of participants. Conclusions. Polymorphism of FokI, but not of BsmI of the VDR gene is associated with structural and functional parameters of the myocardium and aorta in individuals with CVD in the Grodno region of Belarus. With the greatest frequency, LV hypertrophy occurs with Ff (37.9 %) and Bb (33.8 %).Цель исследования – сравнение структурно-функциональных показателей миокарда при разных генотипах полиморфных маркеров BsmI (B/b) (rs1544410) и FokI (F/f) (rs2228570) гена рецептора витамина D (VDR) у лиц с сердечно-сосудистыми заболеваниями (ССЗ). Материалы и методы. Обследовано 198 пациентов с ССЗ. Определение BsmI и FokI гена VDR проводили методом полимеразной цепной реакции. Содержание в крови паратиреоидного гормона, 25(OH)D общего, эндотелина-1, активность ренина плазмы определяли методом иммунофер- ментного анализа. Определение в крови уровня кальция и фосфора проводилось колориметрическим методом. Эхо- кардиография выполнялась аппаратом GE Logic P5 Premium (Корея) фазированным секторным датчиком с частотой 2–4 мГц в режимах М-, В-, PW, CW. Результаты. Все обследованные были разделены на группы по генотипам FokI и BsmI гена VDR. При каждом полиморфизме группы были сопоставимы по возрасту, ССЗ, значениям артериального давления, частоте сердечных сокращений, индексу массы тела и уровням оцененных биомаркеров. Установлены достоверные (p < 0,05) отличия по размерам отделов аорты, левого предсердия (ЛП), размерам и объемам левого желудочка (ЛЖ) и его стенок, диаметром выходного тракта ЛЖ и фракцией выброса между группами с генотипом FF и ff. Кроме того, установлены отличия (p < 0,05) по размерам отделов аорты, ЛП и толщиной межжелудочковой перегородки между группами с генотипом ff и Ff. По генотипам BsmI гена VDR группы достоверно не отличались по оцененным структурно-функциональным показателям миокарда и аорты. Гипертрофия ЛЖ диагностирована у 78,6 % обследованных. Заключение. Полиморфизм FokI, но не BsmI гена VDR ассоциирован со структурно-функциональными показателями миокарда и аорты у лиц с ССЗ у жителей Гродненского региона Беларуси. С наибольшей частотой гипертрофия ЛЖ встречается при Ff (37,9 %) и Bb (33,8 %) генотипах.