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

Patterns of traumatic long-bone fractures in North-Eastern Nigeria: a prospective multicenter study in 5 tertiary hospitals in Nigeria

Background: Traumatic musculoskeletal injuries have formed a significant burden on healthcare delivery worldwide. Long bone fractures are the most common musculoskeletal injuries encountered in this category and with the advent of insurgency in the northeastern part of Nigeria, there has been a rising incidence of assaults, gunshots, and other traumatic causes of long bone fractures. Methods: A prospective cross-sectional study of patients with traumatic long-bone fractures in north-east Nigeria presenting in the tertiary hospitals involved in the study during the 6months study period (September, 2023 to February 2024). information of all patients presenting with traumatic long bone fractures were collected; biodata, presenting complains and findings on examination including the Glasgow coma scores were collected and documented. Radiological findings and intervention given. All information were collected and documented using a structured questionnaire. Data collected were analyzed using SPSS version 29. Results: 227 patients were seen from the five major tertiary centers in north-eastern Nigeria that participated in the study. The 123 patients (54.2%) from Abubakar Tafawa Balewa university teaching hospital (ATBUTH)-Bauchi, 43 patients (18.9%) from Modibo university teaching hospital (MAUTH)-Yola, 32 patients (14.1%) were seen in Federal medical center (FMC)-Jalingo, 18 patients (7.9%) from federal teaching hospital (FTH)-Gombe and 11 patients (4.8%) from Maiduguri teaching hospital Maiduguri (UMTH)-Maiduguri. The 178 (79.1%) were males and 47(20.9%) females, making a male to female ratio of 4:1. Conclusions: Long bone fracture causes a significant health care burden in north-East Nigeria with a high incidence of road traffic accidents, assaults and gunshots likely from the increasing effects of insurgency and kidnappings activities in this region.