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

Squaraine-based long wavelength fluorescent chemosensors for ions - The design, synthesis and characterization of a new class of red to NIR fluorescent chemosensors

Fluorescent chemosensors which con be excited al the red-end of the visible spectrum offer a number of advantages. Squaraines when modified appropriately, ore shown to yield such chemosensors signalling various ions in acetonitrile and water

Remarkable cooperative action of two zinc centers in the hydrolysis of plasmid DNA

A novel binuclear zinc complex has been synthesized. The complex is highly efficient in the hydrolysis of plasmid DNA at pH 7.5. Furthermore, a comparison to a mononuclear complex reveals a high level of cooperativity between the two metal ion centers

Remarkable phosphodiester hydrolysis activity of a novel Ce-IV complex in neutral aqueous solutions

A novel Ce-IV-complex of 1,4,7-tris(carbamoylmethyl)-1,4,7-triazacyclononane has been synthesized. The complex is both stable in aqueous solutions at neutral pH and very efficient in promoting the hydrolysis of a phosphodiester model compound and yeast tRNA(phe). The RNA model compound, 2-hydroxypropyl-p-nitrophenylphosphate hydrolysis is accelerated 7400-fold at pH 7.5, as a result of an unprecedented hydrolytic activity

A novel lanthanide complex with remarkable phosphodiester transesterification activity and DNA-conjugatable functionality

Encapsulated lanthanide complexes like the TCMC complexes are highly stable under physiological conditions. With the ultimate goal being an in vivo application of these complexes as a sequence-selective RNA/DNA cleaving agent (artificial RNAse/DNAse), kinetic stability of the complex would be a distinct advantage. We have synthesized a novel lanthanide complex with such stability and which displays high transesterification activity. The most important attribute of this compound is the nitrophenyl group which would allow further derivatization and conjugation to a DNA oligomer, thus creating a potential for the sequence selective hydrolysis of its target

Modulation of boradiazaindacene emission by cation-mediated oxidative PET

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A calixpyridinium-pyranine complex as a selective anion sensing assembly via the indicator displacement strategy

The recently reported calixpyridinium tetracation is shown to be very well-suited for anion sensing via the indicator displacement strategy. A very strong binding interaction between the positively charged receptor and the fluorescent pH indicator pyranine (8-hydroxy-1,3,6-pyrenetrisulfonate) requires an anionic guest of comparable negative charge for effective indicator displacement. Thus, selective and sensitive signalling of ATP is achieved in aqueous solutions

Chemosensing in deep red: A squaraine-based fluorescent chemosensor for pH.

We have synthesized and spectrally characterized a squaraine-based fluorescent chemosensor for pH. This chemosensor unlike many others, works in 100 % aqueous solutions, signalling the pH change from 10 to 7 by a 11-fold increase in the emission intensity at 651 nm, when excited at the isosbestic point (614 nm). The average pK(a) for the ionizable groups is found to be 8.8. The chemosensor with its molar extinction coefficient > 200,000 and the quantum yield of 0.2, yield an impressive intrinsic brightness value of 40,000. (C) 1997 Elsevier Science Ltd