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

Knowledge, attitude and practice of community pharmacists toward irritable bowel syndrome, Sudan

Irritable Bowel Syndrome (IBS) is a common disorder affecting around 20% of the populations worldwide. Treatment of IBS typically focuses on managing predominant symptoms and the pathophysiology, such as the visceral hypersensitivity. This study was conducted to assess community pharmacist knowledge, attitude and practice of Irritable Bowel Syndrome in Khartoum locality.A descriptive cross-sectional study was done. The study was performed among all community pharmacist working at the pharmacies in the study area. Ethical approval from the Ministry of health was first granted (NUSU2021/3-5), then approvals was obtained from each of pharmacy administration. Pharmacists that were registered by Sudan medical counsel, while pharmacy technician and other staff were excluded. Association among variables was assessed through chi-square test, all tests were considered significant when p <0.05.Most of the pharmacist were females (68%, n= 70). Fifty-eight percent (n=60) had good knowledge about IBS. Ninety-three percent (n=96) knew the common symptoms. Eighty-six percent (n=89) of the participants reported that the diagnosis of IBS was based on symptoms. Although the knowledge score was good, but their knowledge about medications and lifestyle modifications was poor. Good attitude was noticed in 55% (n= 57) of the pharmacists. Sixty-one percent (n=63) of pharmacists agree with that they need courses regarding IBS. Fifty-one percent (n= 53) of them agreed with IBS has become one of the most health problems they were involved. Also fifty-one percent (n=53) of them agree with that the symptoms of IBS never disappear. Regarding practice, 63% (n= 65) of pharmacists had good practice.Majority of the participants had good knowledge and attitude and practice about IBS. The need for continuous education was recommended by the participants