Research Projects

Safer Evidence

Optimising Perioperative Analgesic strategies for eLective Surgery (OPALS)

Severe pain after surgery is common and distressing, affecting nearly one in five patients within 24 hours of a big operation. Poorly controlled pain slows recovery, strains the heart, increases risk of blood clots and chest infections and delays hospital discharge. Strong painkillers (opioids) are commonly used for pain control but have side effects and can be addictive. Alternatives include nerve injections and non-opioid medications, but the best combinations of treatments for different surgeries and types of patients, like those with chronic pain, are not well known.
 
We will analyse electronic patient records to identify the most effective treatments for reducing pain after big operations, whilst minimising harmful side effects, like opioid dependence. The goal is to provide immediate guidance to clinicians on the best combinations of pain-relieving treatments for patients during and after surgery, and to identify which approaches should be formally tested in future clinical trials. We will create a database, containing detailed information about thousands of surgical patients from three NHS Trusts including 18 hospitals.  We will examine links between different pain management approaches, for different types of surgery, and how patients do afterwards. This hospital data will be combined with community pharmacy data to identify who remained on opioids for more than 3 months after surgery, and anything which placed them at risk of this problem we want to avoid.
 
Analysis of the care of so many patients, in greater detail than previously possible, will provide a uniquely accurate insight into current approaches to pain management after surgery, and how effective and safe they are. Finally, we will design a clinical trial of different pain strategies, consulting patients and clinicians on its design, using to maximise the potential for efficient delivery, at low cost. This project has been co-designed with people who have lived experience of surgery and postoperative pain, and we will build their input into each stage of the project going forward.
 
The OPALS study will bring new knowledge about how best to treat the pain patients experience during and after surgery and will test the feasibility of testing promising pain-relieving strategies in future clinical trials.

Lead Investigators

Matthew Wilson

Ramani Moonesinghe