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

Mn3_3O4_4/ZnO-Al2_2O3_3-CeO2_2 mixed oxide catalyst derived from Mn-doped Zn-(Al/Ce)-LDHs: efficient visible light photodegradation of clofibric acid in water

International audienceMn$_3$O$_4$/ZnO-Al$_2$O$_3$-CeO$_2$ catalyst was synthesized through a solid-state process from a 3% Mn-doped Zn-(Al/Ce) layered double hydroxide structure. Detailed structural and optical characterization using XRD, FTIR, UV-visible DRS, and TEM was conducted. By investigating clofibric acid (CA) degradation in aqueous solution, Mn$_3$O$_4$/ZnO-Al$_2$O$_3$-CeO$_2$ photocatalytic activity was evaluated. The results show that the heterostructure mixed oxide catalyst has excellent CA photodegradation performance. Further, the characterization reveals that such photocatalytic efficiency can be attributed to two facts that are summarized in the optical properties and the synergic effect between Mn and Ce elements. The sample demonstrated a narrow band gap of 2.34 eV based on DRS. According to the experimental results of the photodegradation, after 120 min of irradiation, the photocatalyst exhibited the highest photocatalytic activity, with a degradation efficiency of 93.6%. Optimization outcomes indicated that maximum degradation efficiency was attained under the following optimum conditions: catalyst dose of 0.3 g/L, initial dye concentration of 20 mg/L, pH 3.86, and 120 min of reaction time. The quenching test demonstrates that photogenerated electrons and superoxide radicals are the most powerful reactive species. The catalyst could be useful in decreasing the photogenerated charges recombination, which offers more redox cycles simultaneously during the catalytic process. The strong Ce-Mn interaction and the formation of their different oxidation states offer a high degradation efficiency by facilitating electron-hole transfer. The introduction of Mn$_3$O$_4$ in the catalyst can effectively improve the visible absorption properties, which are beneficial in the photocatalytic process by reaching a high catalytic efficiency at a low cost