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

Rare Image of Epidural Catheter Fracture in Lumbar Analgesia

Objective. Accidental fracture of epidural analgesia catheters has a very low incidence of 2.5 per 100,000 anesthesia. A rare image of the fracture is reported. Methods. A 42-year-old female patient was attending a cesarean section eight years earlier to her consult. In the cesarean section, she received regional epidural anesthesia, and the main complaint was low back pain, specifically between the spinous processes L2 and L3. The somatic pain had been presenting intermittently for eight years. The sagittal section of magnetic resonance imaging of the lumbar spine showed a “golf club” image from the midline to the laminae of L2 and L3 with the subcutaneous tissue. Results. A small right hemilaminectomy was performed to remove the complete catheter, which did not adhere, but was coiled in the S-shape. The catheter was trapped between the left facets of L2 and L3 laterally than through the midline. Several risk factors and therapeutic procedures have been proposed. Conclusion. In a systematic review, 24 articles were reported on this specific issue. No surgical procedure and follow-up were informed by 8 authors. Surgical remotion by laminectomy was used in 9 articles, surgical explanation by skin incision was reported by 4 authors, and remotion by endoscopy was reported in 1 article. Two articles not reported solution