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

Seasonal and species variations in the nutritive value of eucaliptus foliage as a potential feed resource for ruminants in silvopastoral systems

10 páginas, 1 figura, 4 tablas.The objective of the study was to evaluate the nutritional value of leaves from fve eucalyptus species (Eucalyptus astringens, E. leucoxylon, E. sideroxylon, E. lehmannii, E. camaldulensis), harvested in Tunisia (two locations) during the autumn, winter, and spring seasons. Chemical composition and digestibility (various in vitro procedures) and in vitro tannin biological activity were determined. The species E. lehmannii had the lowest neutral detergent fber (NDF) and lignin contents (252 and 92 g kg−1 dry matter (DM), respectively) and the highest nonfbrous carbohydrates content (553 g kg−1 DM), while the species E. leucoxylon and E. camaldulensis had the highest NDF concentrations (375 and 356 g kg−1 DM, respectively). Among the seasons, higher levels of NDF and lignin were observed in winter (349 and 129 g kg−1 DM, respectively). The species E. sideroxylon showed the highest gas production with polyethylene glycol addition and thus the highest biological tannin activity. The species E. lehmannii and E. camaldulensis had the highest metabolizable energy concentrations, with 6.20 and 6.07 MJ kg−1 DM, respectively. E. camaldulensis showed the highest (37.9%) and E. lehmannii the lowest (31.9%) organic matter digestibility. Foliage from eucalyptus trees are of limited energy and protein value as an alternative fodder for ruminants, with a substantial variability across species. No remarkable seasonal variations in chemical composition and digestibility of eucalyptus foliage were detected.Peer reviewe