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

Comprehensive Review on Fault Ride-Through Requirements of Renewable Hybrid Microgrids

The world is interested in applying grid codes to increase the reliability of power systems through a micro-grid (MG). In a common practice, the MG comprises a wind farm, and/or photovoltaic (PV) arrays that are integrated with diesel generators and energy storage devices. Fault ride-through (FRT) capability is an important requirement of grid codes. FRT means that the MG is still connected to the grid during numerous disturbances such as faults. This is required to ensure that there is no loss of power generated due to grid faults. Reactive currents must be injected into the grid to increase the power system stability and restore voltage. To enhance FRT for doubly fed induction generator (DFIG) based WT installation, internal control modifications of rotor-side converters and grid-side converters are applied. The solutions that depend on these modifications are traditional and advanced control techniques. Advanced control techniques are needed due to the non-linear nature and less robustness of traditional ones. External hardware devices are also added to improve the FRT of DFIG which are classified into protection devices, reactive power injection devices, and energy storage devices. A comprehensive review of FRT enhancements of DFIG-based WTs, PV systems, and MGs using hardware and software methods is presented in this effort. A classification of FRT of PV systems is characterized plus various inverter control techniques are indicated. Several FRT methods for hybrid PV-WT are presented, with full comparisons. The overall operation and the schematic diagrams of the DFIG-WT with FRT methods are discussed and highlighted. Many Robust control methods for controlling grid connected AC, DC and hybrid AC/DC MGs in power systems are addressed. A total of 210 reported articles were review, including the most up-to-date papers published in the literature. This review may be used as the basis to improve system reliability for those interested in FRT methods. Various traditional and advanced control techniques to improve the FRT abilities are summarized and discussed, including protection devices, reactive power injection devices, and energy storage. In addition, the classifications of FRT hardware methods for DFIG are presented, including grid code requirements