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

Fresh crushed garlic exhibits superior allicin and pyruvic acid stability, while fresh sliced garlic leads in phenolic and antioxidant content

This study investigates the stability of allicin, phenols, and antioxidants in different forms of garlic (fresh whole peeled, fresh sliced, fresh crushed, and dried slices) under various storage conditions (0 to 2 days at 4 ºC and 20 ºC). The garlic contents of allicin and pyruvic acid, total phenols, and antioxidant activity were determined. Sensory evaluation of hummus samples, enriched with garlic in varying treatments, was conducted by 40 participants to assess acceptability and intensity of flavor, aroma, and pungency. Fresh garlic exhibited allicin levels ranging from 0.6 to 32.14 mg/g, while dried garlic showed significantly lower levels (3.77 to 6.68 mg/g). Maximum allicin stability in fresh garlic was observed after 10 min at 20 ºC, with pyruvic acid peaking after 10 min at 4 ºC. Freshly sliced and crushed garlic retained the highest phenol content and antioxidant activity immediately after preparation, whereas dried garlic had reduced levels due to thermal processing. Consumer testing revealed that hummus with fresh crushed garlic at 10 min and 20 ºC was preferred, while dried garlic at 20 min and 4 ºC had the strongest flavor and aroma. In conclusion, fresh crushed garlic is optimal for allicin and pyruvic acid content, while fresh sliced garlic excels in phenol and antioxidant levels; drying notably diminishes these beneficial compounds, affecting flavor and consumer preference. According to these results, consuming the fresh garlic after 10 min of mashing it at room temperature is recommended for optimal allicin yield and pungency

Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model

Opioids are frequently overprescribed after surgery. We applied a tabular foundation model to predict the risk of post-discharge opioid consumption. The model was trained and internally validated on an 80:20 training/test split of the ‘Opioid PrEscRiptions and usage After Surgery’ (ACTRN12621001451897p) study cohort, including adult patients undergoing general, orthopaedic, gynaecological and urological operations (n = 4267), with external validation in a distinct cohort of patients discharged after general surgical procedures (n = 826). The area under the receiver operator curve was 0.84 (95% confidence interval [CI] 0.81–0.88) at internal testing and 0.77 (95% CI 0.74–0.80) at external validation. Brier scores were 0.13 (95% CI 0.12–0.14) and 0.19 (95% CI 0.17–0.2). Patients with a <50% predicted risk of opioid consumption consumed a median of 0 oral morphine equivalents in the first week after surgery. Applying this model would reduce opioid prescriptions by 4.5% globally, and counterfactual modelling suggests without increasing time in severe pain (−4.3%, 95% CI −17.7 to 8.6)