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

Evaluation of the Occlusal Contact between the Opposing Teeth and the Cusp of Carabelli in Maxillary Permanent First Molars in Patients Visiting Peshawar Dental College

Background: The Cusp of Carabelli is a small additional cusp which is situated on the mesiopalatal surface of first maxillary molars. This nonfunctional cusp comes in many forms including furrows, ridges or pits and is collectively known as the Carabelli trait Objective: To evaluate the frequency of the occlusal contacts between the accessory cusp of Carabelli and the opposing arch tooth among both genders in patients attending the out-patients department of Peshawar Dental Hospital, Peshawar Methodology: This descriptive cross-sectional study was conducted on 300 subjects visiting the OPD of Peshawar Dental Hospital from October 2022 to December 2022. The sample size was calculated using WHO formula N=p(100-p)z2/d2 (Http://www.fao.orgThe age group selected for the participants was from 13-30 years. Consecutive sampling technique was used.). Articulating paper was used to assess the occlusal contacts caused by the cusp of Carabelli. The data were analyzed using SPSS version 20. Pearson’s chi square test was applied to analyze the data. P value of ≤ 0.05 was considered statistically significant. Results: The results of the current study showed that 10.7% of the participants experienced occlusal contacts caused by the presence of their accessory cusp with the opposing arch tooth with no statistically significant difference between genders. Conclusion: The cusp of Carabelli is the most prevailing variation found on the palatal aspect of mesiopalatal cusp of permanent maxillary first molars in a hospital-based inhabitants of Peshawar with rare occlusal contacts experienced by the patients. Key words: Cusp of Carabelli, Maxillary permanent first molars, Occlusal contact