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

Quality of life assessment in patients with duchenne muscular dystrophy

Background: Duchenne muscular dystrophy is associated with variable physical and psychosocial sequalae, to patients and their caregivers. Aim: This study aimed to assess quality of life in various dimensions in children with Duchenne Muscular Dystrophy (DMD) and in their caregivers. Patients and methods: This study included all children diagnosed with Duchene Muscular Dystrophy (DMD) registered in the Pediatric Neurology Clinic of Alexandria University Specialized Children’s Hospital. Pediatric Quality of Life (PedsQL ™ 3.0) Duchenne Muscular Dystrophy Module was applied to the children and their caregivers. Results: In toddler group, the mean score was 34.41 ± 26.84 SD for daily activity, 48.64 ± 21.41 SD for medications, 28.71 ± 20.70 SD for anxiety, 60.15 ± 21.01 SD for communication and 42.98 ± 15.41 SD and for total quality of life. In parents’ group, the mean scores were as following: 45.35 ± 30.66 SD for daily activity, 50.32 ± 18.79 SD for medications, 20.40 ± 19.32 SD for anxiety, 54.59 ± 20.92 SD communication and 42.55 ± 14.86 SD for total quality of life. Conclusion: Duchenne muscular dystrophy causes significant impairment in all aspects of quality of life in patients and their caregivers