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

Hydrologically Induced Deformation in Long Valley Caldera and Adjacent Sierra Nevada

Vertical and horizontal components of GNSS displacements in the Long Valley Caldera and adjacent Sierra Nevada range show a clear correlation with hydrological trends at both multiyear and seasonal time scales. We observe a clear vertical and horizontal seasonal deformation pattern primarily attributable to the solid earth response to hydrological surface loading at large-to-regional (Sierra Nevada range) scales. Several GNSS sites, located at the eastern edge of the Sierra Nevada along the southwestern rim of Long Valley Caldera, also show significant horizontal deformation that cannot be explained by elastic deformation from surface loading. Due to the location of these sites and the strong correlation between their horizontal displacements and spring discharge, we hypothesize that this deformation reflects poroelastic processes related to snowmelt runoff water infiltrating into the Sierra Nevada slopes around Long Valley Caldera. Interestingly, this is also an area where water infiltrates to feed the local hydrothermal system, and where snowmelt-induced earthquake swarms have been recently detected

Lithospheric Sill Intrusions and Present‐Day Ground Deformation at Rhenish Massif, Central Europe

Abstract The Rhenish Massif in Central Europe, which includes the Eifel Volcanic Fields, has shown ongoing ground deformation and signs of possible unrest. A buoyant plume exerting uplift forces at the bottom of the lithosphere was proposed to explain such deformation; the hypothesis of (possibly concurrent) melt accumulation in the crust/lithospheric mantle has not been explored yet. Here, we test deformation models in an elastic half‐space considering sources of varying aspect ratio, size and depth. We explore the effects of data coverage, noise and uncertainty on the inferred source parameters. We find that the observed deformation would require melt accumulation in sub‐horizontal sill‐like structures expanding at the rate of up to ∼0.045 km3/yr. We discuss feasibility, limitations and possible interpretations of our resulting models and elaborate on further observations which may help constrain the structure of the Rhenish Massif magmatic system

The 2011-2019 Long Valley Caldera inflation: New insights from separation of superimposed geodetic signals and 3D modeling

Increasingly accurate, and spatio-temporally dense, measurements of Earth surface movements enable us to identify multiple deformation patterns and highlight the need to properly characterize the related source processes. This is particularly important in tectonically active areas, where deformation measurement is crucial for monitoring ongoing processes and assessing future hazard. Long Valley Caldera, California, USA, is a volcanic area where frequent episodes of unrest involve inflation and increased seismicity. Ground- and satellite-based instruments show that volcanic inflation renewed in 2011, and is continuing as of early 2021. Additionally, Long Valley Caldera is affected by the large, but spatially and temporally variable, amounts of precipitation falling on the adjacent Sierra Nevada Range. The density and long duration of deformation measurements at Long Valley Caldera provide an excellent collection of data to decompose time-series and separate multiple superimposed deformation sources. We analyze Global Navigation Satellite System (GNSS) time-series and apply variational Bayesian Independent Component Analysis (vbICA) decomposition method to isolate inflation-related signals from other processes. We show that hydrological forcing causes significant horizontal and vertical deformation at different temporal (seasonal and multiyear) and spatial (few to hundreds of km) scales that cannot be ignored while analyzing and modeling the tectonic signal. Focusing on the last inflation episode, we then improve on prior simplistic models of the inflation reservoir by including heterogeneous subsurface material properties and topography. Our results suggest the persistence and stability of the reservoir (prolate ellipsoid at about 8 km beneath the resurgent dome) and indicate a 40-50% reduction of the inflation rate after about 3 years from the inflation onset. The onset of the reduced inflation rate corresponded in time with the occurrence of a strong seismic swarm in the Caldera, but also to the temporal variation of climatic conditions in the area

A Decade of Water Storage Changes Across the Contiguous United States From GPS and Satellite Gravity

Increased climate variability is driving changes in water storage across the contiguous United States (CONUS). Observational estimates of these storage changes are important for validation of hydrological models and predicting future water availability. We estimate CONUS terrestrial water storage anomalies (TWSA) from 2007–2017 using Global Positioning System (GPS) displacements, constrained by lower-resolution TWSA observations from Gravity Recovery and Climate Experiment (GRACE) satellite gravity—a combination that provides higher spatiotemporal resolution than previous estimates. The relative contribution of seasonal, interannual, and subseasonal TWSA varies widely across CONUS watersheds, with implications for regional water security. Separately, we find positive correlation between TWSA and the El Niño/Southern Oscillation in the southeastern Texas-Gulf and South Atlantic-Gulf watersheds and an unexpected negative correlation in the southwest. In the western United States, atmospheric rivers (ARs) drive a large fraction of subseasonal TWSA, with the top 5% of ARs contributing 73% of total AR-related TWSA increases