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

Optimisation des structures métalliques fléchies dans un calcul plastique

The steel structure is a type of construction that is very developed in civil engineering. In the phase of survey and then of execution and installation of a metal work, the phase of conception is often the place of discontinuities that prevents the global optimization of material steel. In our survey, we used the traditional approach of optimization that is essentially based on the minimization of the weight of the structure, while taking advantages of plastic properties of steel in the case of a bending structure. It has been permitted because of to the relation found between the areas of the sections of the steel elements and the plastic moment of these sections. These relations have been drawn for different types of steel. In order to take advantages of the linear programming, a simplification has been introduced in transforming these relation to linear relations, which permits us to use simple methods as the simplex theorem. This procedure proves to be very interesting in the first phases of the survey and give very interesting results

The Nucleation of Co Bubbles in Molten Ironcarbon Drops Reacting with Oxidizing Gases

A theoretical representation has been developed for the supersaturation of molten iron drops with respect to carbon monoxide caused by the counter diffusion of carbon and oxygen. These theoretical predictions were compared with experimental measurements obtained using droplets, 4 to 6 mm in diameter at temperatures ranging from 1600 °C to 2000 °C under levitated conditions and with free fall. The agreement between the theoretically predicted and the experimentally measured limits for the onset of the carbon boil was very good, assuming that the effective diffusivity in levitated drops was about three times the molecular diffusivity. This observation is consistent with calculations of flow and mixing in electromagnetically levitated metal droplets

Analgesic effects of ultrasound guided paravertebral block versus transversus abdominis plane block in hepatic patients undergoing laparoscopic cholecystectomy: PVB vs TAP in hepatic patients

Background: Several analgesic modalities after laparoscopic cholecystectomy were used in hepatic patients but with various complications. Bilateral ultrasound-guided transverse abdominis plane block (TAP) or thoracic paravertebral block (PVB) may provide safer techniques than others. The aim of this study is to delineate the more efficient and safer technique either TAP or PVB in hepatic patients. Methods: The research was conducted on sixty adult hepatic patients, ASA II or III, Child A or B, undergoing laparoscopic cholecystectomy. Patients were allocated randomly into one of two equal groups, to attain bilateral ultrasound guided either PVB (Group P) or TAP block (Group T). Group P showed significant postoperative lower pain scores using visual analogue score at 2, 4, 6 and 24 h (P < 0.01) and less intraoperative desflurane and fentanyl consumption (P < 0.001) versus group T. In addition, group P exhibited less total postoperative pethidine requirement (23.3±25.4 mg vs. 38.3±21.5 mg, P = 0.017), fewer number of patients asked for postoperative analgesia (46.7% vs. 76.7%, P value = 0.017), longer duration to first analgesic demand (20.5±5.1 h vs. 15.1±8.4 h, P = 0.021), and compared to group T respectively. Regarding liver functions and haemodynamics, both groups were comparable at different intervals