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

Desde la memoria. El testimonio de la vida de la mujer en Valleseco en la primera mitad del siglo XX

This work is based on the testimony of the women protagonists through their own voices, recounting many aspects related to life in the origins of the Valleseco neighborhood. Located at the foot of the north slope of the Tahodio ravine, in the ravine that gives it its name, is the story of women who bring grief, hope, resistance, humour and solidarity. Beyond the local story, it is projected into the universal drama of survival, the struggle to overcome adversity and how to overcome the cruel embrace of misery. As a result of the long work carried out by the Anaga Women's Association for years, it had its moment in 2004 with the holding of an exhibition that collected the testimonies and the photographic material produced. In this article we rescue a part of that material and expand it with the incorporation of new photographs and testimonies.Este trabajo tiene como eje el propio testimonio de las mujeres protagonistas a través de su voz, que relatan muchos aspectos relacionados con la vida en los orígenes del barrio de Valleseco, al pie de la vertiente norte del barranco de Tahodio, en el barranco que le da nombre. Allí se desarrolla la historia de unas mujeres que traen el desconsuelo, la esperanza, la resistencia, el humor, la solidaridad. Más allá del relato localista, se proyecta en el drama universal de la supervivencia, la lucha para la superación de las adversidades y de cómo sobreponerse al cruel abrazo de la miseria. Fruto del largo trabajo realizado por la Asociación de Mujeres Anaga durante años, tuvo su momento en el año 2004 con la realización de una exposición que recogía los testimonios y el material fotográfico elaborado. En este artículo rescatamos una parte de ese material y lo ampliamos con la incorporación de nuevas fotografías y testimonios