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

Bonding Low-density Nanoporous Metal Foams Using Sputtered Solder Bonding Low-density Nanoporous Metal Foams Using Sputtered Solder

INTRODUCTION A method has been developed for bonding low-density nanoporous metal foam components to a substrate using solder that is sputtered onto the surfaces. Metal foams have unusual properties that make them excellent choices for many applications, and as technologies for processing these materials are evolving, their use in industry is increasing dramatically. Metal foams are lightweight and have advantageous dynamic properties, which make them excellent choices for many structural applications. There are many applications that require micro-scale metal foams precisely bonded to substrates. This study was motivated by a physics experiment that used a laser to drive a shock wave through an aluminum foil and into a copper foam, in order to determine the speed of the shock in the copper foam. To avoid disturbing the shock, the interface between the copper foam and the aluminum substrate had to be as thin as possible. There are many other applications that could benefit from the bonding technology developed in this study, such as small-scale lightweight structural members, high-strength thermal insulating layers for electronics, and micro-scale mechanical dampers, to name but a few. Each of these applications requires one or more small metal foam components precisely bonded to a substrate. Several methods for bonding metal foam components have been developed by previous researchers. [5] Macroscopic metal foam parts have been successfully bonded by laser welding to create T-sections and butt joints. [6] Ultrasonic welding has been used to join aluminum sheet metal to aluminum foam for structural applications