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

A commercial seaweed extract increases growth performance, immune responses, and related gene expressions in whiteleg shrimp (Litopenaeus vannamei)

Seaweed liquid extracts are an attractive source of phytochemicals with high potential applicability in the aquafeed-additive industry. A commercial seaweed liquid extract (True Algae Max, TAM®), which has a marine seaweed odor, also dislplays significant levels of polysaccharides, phytochemicals, phenolic, and flavonoid compounds showing antioxidant activities and DPPH inhibition. This study investigates the impact of diets supplemented with TAM® as a functional additive on the growth, nutrient utilization, immune responses, and immune-related gene expressions of whiteleg shrimp (Litopenaeus vannamei). A total of 750 postlarvae (PL, with an average initial weight of 0.053±0.001 g) were divided into five experimental groups, comprising three replicates per dietary treatment. For an eight-week experimental period, all groups were fed identical diets except for the variation in TAM® inclusion levels. The basal diet (control diet) had no inclusion level of TAM® (TAM0%). Groups 2–5 each contain TAM® inclusion at levels of 1% (10 mL gk− 1 diet TAM1%), 2% (20 mL gk− 1 diet TAM2%), 3% (30 mL gk− 1 diet TAM3%), and 4% (40 mL gk− 1 diet TAM4%), respectively. The results concluded that TAM® has great potential as a feed additive for whiteleg shrimp, compared to the control group. The group TAM2% significantly achieved final weight (4.337 g), weight gain (4.287 g) specific growth rate (3.423% / day), feed conversion ratio (1.970), feed efficiency ratio (0.507), and protein efficiency ratio (1.407), compared to the control group (3.900 g, 3.850 g, 3.347%/day, 2.183, 0.458, and 1.270, respectively). Whole-body composition of protein and lipid contents were significantly improved by all TAM group including TAM2% (51.18% and 4.49%, respectively), compared to the control group (49.38% and 4.15%, respectively). As well as, shrimp in group TAM2% achieved the highest values of lysozyme (3.92 µg mL− 1 ), superoxide dismutase (SOD, 11.92 IU mL− 1 ), catalase (CAT, 13.04 IU g− 1 ), lipase (31.24 IU L− 1 ), and amylase (31.24 IU L− 1 ), compared to the control group (3.19 µg mL− 1 , 8.80 IU mL− 1 , 10.84 IU g− 1 , 17.35 IU L− 1 , 21.65 IU L− 1 , respectively). For gene expressions experiment, four immune-related were performed in this study; Peroxiredoxin (Prx), Prophenoloxidase (PPO1), P53-like protein isoform delta (p53), and Hemocyanin subunit L5 (L5H). The results showed that shrimp in group TAM2% achieved the highest significant P53 gene transcription compared to the control group or the other TAM groups. Compared to other groups, the TAM1% group considerably increased PPO1 gene transcription, while TAM3% displayed the greatest Prx gene transcription. On the other hand, compared to control group, all TAM groups significantly improved L5H gene transcription. In conclusion, the current study revealed that TAM® diet supplementation (20 mL of TAM® per kg diet) represents a promising, eco-friendly, and sustainable feed additive in the shrimp aquadiet industry