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

Jurists Uprooted : German-speaking Émigré Lawyers in Twentieth-century Britain

Contents List of Contributors List of Abbreviations xiv ‘Was Heimat hieß, nun heißt es Hölle’ The emigration of lawyers from Hitler’s Germany: political background, legal framework, and cultural context by Reinhard Zimmermann Aliens, Enemy Aliens, and Friendly Enemy Aliens Britain as a Home for Emigré and Refugee Lawyers by Jack Beatson Fritz Schulz (1879–1957) by Wolfgang Ernst Fritz Pringsheim (1882–1967) by Tony Honoré David Daube (1909–1999) by Alan Rodger Roman Law in Twentieth-century Britain by Peter Birks Hermann Kantorowicz (1877–1940) and Walter Ullmann (1910–1983) by David Ibbetson Otto Kahn-Freund (1900–1979) by Mark Freedland Ernst J. Cohn (1904–1976) by Werner Lorenz Comparative Law in Twentieth-century England by J. A. Jolowicz Clive M. Schmitthoff (1903–1990) by John N. Adams F. A. Mann (1907–1991) by Lawrence Collins Martin Wolff (1872–1953) by Gerhard Dannemann Kurt Lipstein (*1909) by Christopher Forsyth Private International Law in Twentieth-century England by Peter North Wolfgang Friedmann (1907–1972), with an Excursus on Gustav Radbruch (1878–1949) by John Bell Gerhard Leibholz (1901–1982) by Manfred H. Wiegandt Lassa Oppenheim (1858–1919) by Mathias Schmoeckel Hersch Lauterpacht (1897–1960) by Martti Koskenniemi Georg Schwarzenberger (1908–1991) by Stephanie Steinle Public International Law in Twentieth-century England by James Crawford Hermann Mannheim (1889–1974) and Max Grünhut (1893–1964) by Roger Hood Emigré Legal Scholars in Britain—Personal Recollections by Peter Stein German Refugees in Oxford—Some Personal Recollections by Barry Nicholas Kurt Lipstein—The Scholar and the Man by Christian v. Bar Cambridge 1933–2002 by Kurt Lipstein Appendix by Frank Wooldridge, Jack Beatson, Reinhard Zimmerman