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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The Microbial Degradation for Pectin

Pectin considers one of the most plentiful natural components having many applications. It is widely distributed in the middle lamella and cell walls of the terrestrial plant in various concentrations. Pectin is a heteropolysaccharide that involved galacturonic acid and methanol as the main components. Pectin is degraded by the pectinase enzyme, producing several compounds that have industrial applications. This Enzyme is produced by several organisms such as plants, protozoa, nematodes, insects, and microorganisms. However, the microbial source is the most common in commercial production due to its massive applications in various industries. Consequently, this chapter will show the importance of microorganisms to degrade pectin, the different types of microorganisms that can degrade pectin, and their applications

The Microbial Degradation for Pectin

Pectin considers one of the most plentiful natural components having many applications. It is widely distributed in the middle lamella and cell walls of the terrestrial plant in various concentrations. Pectin is a heteropolysaccharide that involved galacturonic acid and methanol as the main components. Pectin is degraded by the pectinase enzyme, producing several compounds that have industrial applications. This Enzyme is produced by several organisms such as plants, protozoa, nematodes, insects, and microorganisms. However, the microbial source is the most common in commercial production due to its massive applications in various industries. Consequently, this chapter will show the importance of microorganisms to degrade pectin, the different types of microorganisms that can degrade pectin, and their applications.</jats:p

Clinical Characteristics of Venous Thromboembolism in COVID-19 Patients Admitted to intensive care unit

Abstract Introduction: COVID-19 infection was associated with many morbid conditions, one of which is venous thromboembolism; however, this is varied in incidence and clinical characteristics, with no known definite risk predictors.Aim: To identify the incidence, clinical characteristics, and risks and outcome of venous thromboembolism in COVID-19 patients.Methods: a retrospective cohort study comparing the recorded data for two groups of patients with confirmed COVID-19 infection and admitted to the ICU in 6 months duration.Results: the incidence of venous thromboembolism was 30%, where pulmonary embolism (PE) alone was the most frequent type (68.2%), followed by, DVT with PE (15.1%), DVT alone (12.1%), cavernous sinus thrombosis alone CST (3%) and the least frequency was CST with renal artery thrombi (1.5%). Smoking and malignancy were more frequent in VTE group with more statistically significant elevation of D dimer. the pulmonary embolism was lobar in the majority of our patients (69.6%), followed by segmental (17.9%), while the least frequency was for massive pulmonary embolism (12.5%).Conclusion: VTE is a common event in COVID-19 patients, where smoking and malignancy more frequent, D dimer is significantly elevated, and more morbidity and mortality in those patients.</jats:p

Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial

Background &amp; objective: The serratus anterior plane block (SAPB) is a recent technique providing effective perioperative analgesia in thoracic surgeries. This study compared the intra–operative hemodynamics and the perioperative analgesic efficacy of superficial SAPB, to deep SAPB, and to thoracic epidural analgesia in thoracotomies.&#x0D; Methodology: one hundred and eighty lung cancer patients scheduled for thoracotomy were randomly allocated to three groups; TEA group, which received thoracic epidural analgesia, SSPB group receiving ultrasound–guided superficial serratus plane block and DSPB group which received US–guided deep serratus plane block. Baseline and intra–operative hemodynamics and total consumption of intraoperative fentanyl and postoperative morphine was noted.&#x0D; Results: Intra–operative mean arterial pressure (MAP) significantly decreased in the TEA group compared to baseline values, whereas no significant changes were found in either SSPB or DSPB groups. Heart rate (HR) did not show significant changes in any group. The time to postoperative analgesic demand was significantly longer in the SSPB and DSPB groups than in the TEA group (p &lt; 0.001). In the first postoperative hour, TEA group had significantly higher visual analogue scale (VAS) scores than SSPB or DSPB groups at rest and with cough. The total consumption of intraoperative fentanyl and postoperative morphine was comparable among all groups.&#x0D; Conclusion: Pre–operative SSPB and DSPB can provide adequate perioperative analgesia without hemodynamic instability when compared to TEA in thoracotomies.&#x0D; Key words: Deep serratus plane block; Superficial serratus plane block; Thoracic epidural analgesia; Analgesia; Thoracotomy&#x0D; Trial registration: The trial was registered at ClinicalTrials.gov with registration number (NCT 04189120). https://clinicaltrials.gov/ct2/show/NCT04189120&#x0D; Citation: Abdelrahman AS, Al Wasseef MM, Hassan ME, Abdelghafar EM. Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial. Anaesth. pain intensive care 2021;25(6):713–721;&#x0D; DOI: 10.35975/apic.v25i6.1690</jats:p