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

RES-Q an Ongoing Project on Municipal Solid Waste Management Program for the Protection of the Saniq River Basin in Southern Lebanon

Lebanon is currently facing an unprecedented mix of social, economic, and political crises, which exacerbate many public health and environmental health problems. Among these, solid waste management (SWM) is considered one of the biggest challenges that Lebanon has been facing for the past two decades. In the absence of national guidelines and ministerial action, SWM is a responsibility of local municipalities. In this paper, we describe the development of a technology-based Waste Management System (WMS) in an area of 43 villages in southern Lebanon. The project is inspired to the paradigms of circular economy and smart cities, and it aims to define affordable and efficient strategies to address SWM. The driving factor in defining the strategies is economic and environmental sustainability, as Lebanon imports most of its resources in hard currency, which is becoming less and less available. The lessons learned from this project can be transposed in other areas and countries with limited financial resources, representing an important paradigm for the WMSs in many areas of the world