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

Nano-tailored multi-functional cementitious composites

WOS: 000509629400050This paper explores the effects of single and binary use of nano-additions on the self-sensing and self-healing efficiencies of cementitious composites in achieving a material that combines high mechanical and multifunctional performances. The researchers studied three nano-tailored cementitious compositions incorporating nano-silica (NS), multi-walled carbon nanotubes (CNT) and binary NS/CNT, as well as control composites prepared without nano-additions. The study included compressive strength testing on sound specimens and an evaluation of combined self-sensing/self-healing capabilities with electrical resistivity (ER) measurements conducted before and after preloading and during the self-healing recovery stage. Recovery rates were also evaluated via crack width measurements recorded by video microscope and compared to ER testing results. To account for different self-healing products, microstructural characterization was performed on healed cracks using scanning electron microscopy coupled with EDX (SEM/EDX) and thermo-gravimetric (TG/DTG) analyses. Results show that while the single use of CNT can promote self-sensing and self-healing properties, using binary NS/CNT can significantly enhance these performances. The density and amounts of C-S-H and CaCO3 in healed cracks increased with the addition of nano-materials, especially for the binary NS/CNT.Scientific and Technical Research Council (TUBITAK) of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [114R043, 117M954]The authors gratefully acknowledge the financial assistance of the Scientific and Technical Research Council (TUBITAK) of Turkey provided under projects: 114R043 and 117M954