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 study of the structural, optical, and ferroelectric characteristics of Pb-Ge-Te nanocrystalline alloys as potential candidates for memory devices and Near-Infrared (NIR) applications

Pb50-xGexTe50 (x = 15, 20, 25, 30 at. %) nanocrystalline bulk alloys were prepared using solid-state direct reaction. X-ray diffraction and high-resolution transmission electron microscopy (HR-TEM) analysis of the reference structure (Ge = 15 at.%) revealed a slightly distorted cubic structure, with a lattice parameter of 6.43 Å and an inter-axis unit cell angle of 88.69°. Atomic force images\u27 analysis and histograms displayed a homogenous particle size distribution in the nanoscale for all samples. Density measurements showed a gradual decrease from 7.89 to 6.98 g/cm3 with increasing Ge content in agreement with the calculated values. The polarization–field hysteresis behavior verifies the ferroelectric activity of the prepared alloys, suggesting them as potential candidates for non-volatile ferroelectric memory devices (NVFRAMs) applications. Optical properties analyzed using diffuse reflectance measurements exhibited direct transitions with a bandgap decreasing from 1.57 to 1.35 eV with increasing Ge content matching the near-infrared spectrum (NIR) perfectly