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

Maintaining utility fairness using weighting factors in wireless networks

Maintaining fairness using weighting factors is a common approach in resource allocation. However, computing weighting factors for multiservice wireless networks is not trivial because users' rate requirements are heterogeneous and their channel gains are variable. In this paper, we propose weighting factor computation and scheduling schemes for orthogonal frequency division multiple access (OFDMA) networks. The weighting factor computation scheme determines each user's share of rate for maintaining a utility notion of fairness. We then present a scheduling scheme which takes the users' weighting factors into consideration to allocate sub-carriers and power in OFDMA networks. The simulation results demonstrate that the proposed scheduling scheme outperforms an opportunistic scheme in terms of fairness performance in different scenarios, where the users are fixed or mobile

Design of fair weights for heterogeneous traffic scheduling in multichannel wireless networks

Fair weights have been implemented to maintain fairness in recent resource allocation schemes. However, designing fair weights for multiservice wireless networks is not trivial because users' rate requirements are heterogeneous and their channel gains are variable. In this paper, we design fair weights for opportunistic scheduling of heterogeneous traffic in orthogonal frequency division multiple access (OFDMA) networks. The fair weights determine each user's share of rate for maintaining a utility notion of fairness. We then present a scheduling scheme which enforces users' long term average transmission rates to be proportional to the fair weights. The proposed scheduler takes the advantage of users' channel state information and the inherent flexibility of OFDMA resource allocation for efficient resource utilization. Furthermore, using the fair weights allows flexibility for realization of different scheduling schemes which accommodate a variety of requirements in terms of heterogeneous traffic types and user mobility. Simulation based performance analysis is presented to demonstrate efficacy of the proposed solution in this paper