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

Encapsulation Method to Protect Unsaturated Fatty Acids from Rumen Biohydrogenation In Vitro

Enrichment of ruminants’ products with polyunsaturated fatty acids is one of the possibilities to introduce these fatty acids into the human diet. However, the rumen biohydrogenation of unsaturated fatty acids limits their quantity and thus bioavailability in the rumen as well as in animal products. The alginate/carrageenan calcium beads of linseed oil were evaluated in vitro to verify the ability of these products to protect polyunsaturated fatty acids from biohydrogenation by ruminal microbes. Encapsulation efficiency was evaluated by measuring the quantity of oil protected by alginate/carrageenan calcium beads as well as changes on linseed oil fatty acids content before and after encapsulation. Experiment was evaluated in vitro using batch culture system. The treatments were: control (Control) without supplements, experimental I (Linseed oil) (control + 4% of linseed oil), experimental II (Beads 1) control + 4% of linseed beads containing 15% oil, experimental III (Beads 2) control + 4% of linseed beads containing 20% oil. Linseed oil and both linseed oil beads were supplemented to substrates at 4% of dietary dry matter. The substrate was composed of a mixture of meadow hay and barley meal in the ratio of 60:40 and incubated for 48h. All samples were analyzed for fatty acids content. The results were 87% and 86% for alginate/carragenan beads loaded with 15vol% linseed oil and alginate/carragenan beads loaded with 20vol% oil, respectively. The encapsulation process didn’t have a significant effect on PUFA fraction (P<0.01).Results indicated that there is no significant difference (P<0.01) between linseed oil fatty acids content before and after encapsulation process. After incubation in batch culture system, linseed beads decreased (P<0.01) total rumen saturated and monounsaturated fatty acids content. Omega 3 and omega 6 fatty acids contents increased statistically (P<0.01) by beads 1 and beads 2 and numerically by linseed oil treatment. In conclusion, new encapsulation method has the potential to protect linseed oil from rumen biohydrogenation in vitro, however, further in vivo experiments are required

Effect of different levels from linseed oil and linseed oil beads on rumen fermentation and microbial parameters using gas production system and rumen simulation technique

Despite the fact that the ruminant diet is rich in Polyunsaturated Fatty Acids (PUFA), ruminant products, such as meat, milk and dairy contain mainly Saturated Fatty Acids (SFA) because of bacterial lipolysis and subsequent biohydrogenation of ingested PUFA in the rumen. The link between SFA consumption and coronary heart disease is well established. The objectives of this study in this field were to find ways of manipulating ruminal microbes to increase the flow of PUFA from the rumen into meat and milk. The main objective of the current study was to evaluate new encapsulation method using biopolymers to protect linseed oil from rumen biohydrogenation and its effect on rumen fermentation and microbial parameters. Gas Production System (GPS) and rumen simulation technique (rustic system) were used in two separated experiments. Within GPS experiment, a mixture was used as a substrate which was comprised of meadow hay and barley meal in the ratio of 60:40. Linseed beads 1 (15% oil), linseed beads 2 (20% oil) and linseed oil were supplemented to the substrate at four levels (0, 2, 4 and 6%) from substrate as DM basis. The overall results from GPS trial concluded that beads 1, beads 2 and linseed oil in the free form at different levels did not have a negative effect on fermentation pattern in most cases. The only negative effect for linseed oil treatment was on protozoa count and it concluded that the encapsulation process has a good benefit to avoid this negative effect for linseed oil. The closed level for control case from these three treatments was 4% which was used for the next experiment. On the rustic system, the basal substrates consisted of grass hay and concentrate (corn meal+rapeseed meal) in a 1:1.5 ratio and were added in the portions of 12 g DM day&lt;sup&gt;-1&lt;/sup&gt;. The treatments were as following: Control (Basel substrate without supplements), beads 1 (control+4% of linseedbeads containing 15% oil), beads 2 (control+4% of linseed beads containing 20% oil) and linseed oil (control+4% of linseed oil). Different fermentation parameters and microbial parameters were measured. The overall conclusion was that unprotected linseed oil had a significant negative effect on ammonia nitrogen andHolotricha protozoa. It also indicated that unprotected linseed oil had a negative effect on total bacteria count but not significant and no significant effect on other fermentation parameters. The results obtained using rustic system as a long term of incubation confirmed the results obtained by GPS as a short term of incubation. The results obtained conclude that unprotected linseed oil supplementation has a negative effect on rumen microflora, however, this negative effect could be avoided by protect linseed oil