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

Lanthanum–Cerium-Modified Nickel Catalysts for Dry Reforming of Methane

The catalyst MNi0.9Zr0.1O3 (M = La, Ce, and Cs) was prepared using the sol–gel preparation technique investigated for the dry reforming of methane reaction to examine activity, stability, and H2/CO ratio. The lanthanum in the catalyst LaNi0.9Zr0.1O3 was partially substituted for cerium and zirconium for yttrium to give La0.6Ce0.4Ni0.9Zr0.1−xYxO3 (x = 0.05, 0.07, and 0.09). The La0.6Ce0.4Ni0.9Zr0.1−xYxO3 catalyst’s activity increases with an increase in yttrium loading. The activities of the yttrium-modified catalysts La0.6Ce0.4Ni0.9Zr0.03Y0.07O3 and La0.6Ce0.4Ni0.9Zr0.01Y0.09O3 are higher than the unmodified La0.6Ce0.4Ni0.9Zr0.1O3 catalyst, the latter having methane and carbon dioxide conversion values of 84% and 87%, respectively, and the former with methane and carbon dioxide conversion values of 86% and 90% for La0.6Ce0.4Ni0.9Zr0.03Y0.07O3 and 89% and 91% for La0.6Ce0.4Ni0.9Zr0.01Y0.09O3, respectively. The BET analysis depicted a low surface area of samples ranging from 2 to 9 m2/g. The XRD peaks confirmed the formation of a monoclinic phase of zirconium. The TPR showed that apparent reduction peaks occurred in moderate temperature regions. The TGA curve showed weight loss steps in the range 773 K–973 K, with CsNi0.9Zr0.1O3 carbon deposition being the most severe. The coke deposit on La0.6Ce0.4Ni0.9Zr0.1O3 after 7 h time on stream (TOS) was the lowest, with 20% weight loss. The amount of weight loss increases with a decrease in zirconium loading

Modification of CeNi0.9Zr0.1O3 Perovskite Catalyst by Partially Substituting Yttrium with Zirconia in Dry Reforming of Methane

Methane Dry Reforming is one of the means of producing syngas. CeNi0.9Zr0.1O3 catalyst and its modification with yttrium were investigated for CO2 reforming of methane. The experiment was performed at 800 °C to examine the effect of yttrium loading on catalyst activity, stability, and H2/CO ratio. The catalyst activity increased with an increase in yttrium loading with CeNi0.9Zr0.01Y0.09O3 catalyst demonstrating the best activity with CH4 conversion >85% and CO2 conversion >90% while the stability increased with increases in zirconium loading. The specific surface area of samples ranged from 1–9 m2/g with a pore size of 12–29 nm. The samples all showed type IV isotherms. The XRD peaks confirmed the formation of a monoclinic phase of zirconium and the well-crystallized structure of the perovskite catalyst. The Temperature Program Reduction analysis (TPR) showed a peak at low-temperature region for the yttrium doped catalyst while the un-modified perovskite catalyst (CeNi0.9Zr0.1O3) showed a slight shift to a moderate temperature region in the TPR profile. The Thermogravimetric analysis (TGA) curve showed a weight loss step in the range of 500–700 °C, with CeNi0.9Zr0.1O3 having the least carbon with a weight loss of 20%

Lanthanum–Cerium-Modified Nickel Catalysts for Dry Reforming of Methane

The catalyst MNi0.9Zr0.1O3 (M = La, Ce, and Cs) was prepared using the sol–gel preparation technique investigated for the dry reforming of methane reaction to examine activity, stability, and H2/CO ratio. The lanthanum in the catalyst LaNi0.9Zr0.1O3 was partially substituted for cerium and zirconium for yttrium to give La0.6Ce0.4Ni0.9Zr0.1−xYxO3 (x = 0.05, 0.07, and 0.09). The La0.6Ce0.4Ni0.9Zr0.1−xYxO3 catalyst’s activity increases with an increase in yttrium loading. The activities of the yttrium-modified catalysts La0.6Ce0.4Ni0.9Zr0.03Y0.07O3 and La0.6Ce0.4Ni0.9Zr0.01Y0.09O3 are higher than the unmodified La0.6Ce0.4Ni0.9Zr0.1O3 catalyst, the latter having methane and carbon dioxide conversion values of 84% and 87%, respectively, and the former with methane and carbon dioxide conversion values of 86% and 90% for La0.6Ce0.4Ni0.9Zr0.03Y0.07O3 and 89% and 91% for La0.6Ce0.4Ni0.9Zr0.01Y0.09O3, respectively. The BET analysis depicted a low surface area of samples ranging from 2 to 9 m2/g. The XRD peaks confirmed the formation of a monoclinic phase of zirconium. The TPR showed that apparent reduction peaks occurred in moderate temperature regions. The TGA curve showed weight loss steps in the range 773 K–973 K, with CsNi0.9Zr0.1O3 carbon deposition being the most severe. The coke deposit on La0.6Ce0.4Ni0.9Zr0.1O3 after 7 h time on stream (TOS) was the lowest, with 20% weight loss. The amount of weight loss increases with a decrease in zirconium loading

Catalytic Performance of Lanthanum Promoted Ni/ZrO2 for Carbon Dioxide Reforming of Methane

Nickel catalysts supported on zirconium oxide and modified by various amounts of lanthanum with 10, 15, and 20 wt.% were synthesized for CO2 reforming of methane. The effect of La2O3 as a promoter on the stability of the catalyst, the amount of carbon formed, and the ratio of H2 to CO were investigated. In this study, we observed that promoting the catalyst with La2O3 enhanced catalyst activities. The conversions of the feed, i.e., methane and carbon dioxide, were in the order 10La2O3 > 15La2O3 > 20La2O3 > 0La2O3, with the highest conversions being about 60% and 70% for both CH4 and CO2 respectively. Brunauer–Emmett–Teller (BET) analysis showed that the surface area of the catalysts decreased slightly with increasing La2O3 doping. We observed that 10% La2O3 doping had the highest specific surface area (21.6 m2/g) and the least for the un-promoted sample. The higher surface areas of the promoted samples relative to the reference catalyst is an indication of the concentration of the metals at the mouths of the pores of the support. XRD analysis identified the different phases available, which ranged from NiO species to the monoclinic and tetragonal phases of ZrO2. Temperature programmed reduction (TPR) analysis showed that the addition of La2O3 lowered the activation temperature needed for the promoted catalysts. The structural changes in the morphology of the fresh catalyst were revealed by microscopic analysis. The elemental compositions of the catalyst, synthesized through energy dispersive X-ray analysis, were virtually the same as the calculated amount used for the synthesis. The thermogravimetric analysis (TGA) of spent catalysts showed that the La2O3 loading of 10 wt.% contributed to the gasification of carbon deposits and hence gave about 1% weight-loss after a reaction time of 7.5 h at 700 °C

Effect of Adding Gadolinium Oxide Promoter on Nickel Catalyst over Yttrium-Zirconium Oxide Support for Dry Reforming of Methane

The dry reforming of methane (DRM) was studied for seven hours at 800 °C and 42 L/(g·h) gas hourly space velocity over Ni-based catalysts, promoted with various amounts of gadolinium oxide (x = 0.0, 1.0, 2.0, 3.0, 4.0, and 5.0 wt.%) and supported on mesoporous yttrium-zirconium oxide (YZr). The best catalyst was found to have 4.0 wt.% of gadolinium, which resulted in ∼80% and ∼86% conversions of CH4 and CO2, respectively, and a mole ratio of ∼0.90 H2/CO. The addition of Gd2O3 shifted the diffraction peaks of the support to higher angles, indicating the incorporation of the promoter into the unit cell of the YZr support. The Gd2O3 promoter improved the catalyst basicity and the interaction of NiO with support, which were reflected in the coke resistance (6.0 wt.% carbon deposit on 5Ni+4Gd/YZr; 19.0 wt.% carbon deposit on 5Ni/YZr) and the stability of our catalysts. The Gd2O3 is believed to react with carbon dioxide to form oxycarbonate species and helps to gasify the surface of the catalysts. In addition, the Gd2O3 enhanced the activation of CH4 and its conversion on the metallic nickel sites

The Effect of Calcination Temperature on Various Sources of ZrO2 Supported Ni Catalyst for Dry Reforming of Methane

Dry reforming of methane (DRM) over an Ni-based catalyst is an innovative research area due to the growing environmental awareness about mitigating global warming gases (CH4 and CO2) and creating a greener route of synthesis. Herein, 5% Ni supported on ZrO2 obtained from various sources was prepared by the impregnation method. The catalysts were calcined at 600, 700, and 800 °C. Furthermore, Ni-RC stabilized with MgO, SiO2, TiO2, and Y2O3 were tested. Characterization techniques employed comprise the N2 physisorption, infrared spectroscopy, Raman, thermogravimetric analysis, XRD, and TEM. The results of the present study indicated that the ZrO2 support source had a profound effect on the overall performance of the process. The best catalyst Ni-RC gave an average conversion of CH4 and CO2 of 61.5% and 63.6% and the least deactivation of 10.3%. The calcination pretreatment differently influenced the catalyst performance. When the average methane conversion was higher than 40%, increasing the calcination temperature decreased the activity. While for the low activity catalysts with an average methane conversion of less than 40% the impact of the calcination temperature did not constantly decrease with the temperature rise. The stabilization of Ni-RC denoted the preference Y2O3 stabilized catalyst with average values of CH4 and CO2 conversion of about 67% and 72%, respectively. The thorough study and fine correlation will be advantageous for technologically suitable Ni-15Y-RC catalysts for DRM

The Effect of Calcination Temperature on Various Sources of ZrO₂ Supported Ni Catalyst for Dry Reforming of Methane

Dry reforming of methane (DRM) over an Ni-based catalyst is an innovative research area due to the growing environmental awareness about mitigating global warming gases (CH4 and CO2) and creating a greener route of synthesis. Herein, 5% Ni supported on ZrO2 obtained from various sources was prepared by the impregnation method. The catalysts were calcined at 600, 700, and 800 °C. Furthermore, Ni-RC stabilized with MgO, SiO2, TiO2, and Y2O3 were tested. Characterization techniques employed comprise the N2 physisorption, infrared spectroscopy, Raman, thermogravimetric analysis, XRD, and TEM. The results of the present study indicated that the ZrO2 support source had a profound effect on the overall performance of the process. The best catalyst Ni-RC gave an average conversion of CH4 and CO2 of 61.5% and 63.6% and the least deactivation of 10.3%. The calcination pretreatment differently influenced the catalyst performance. When the average methane conversion was higher than 40%, increasing the calcination temperature decreased the activity. While for the low activity catalysts with an average methane conversion of less than 40% the impact of the calcination temperature did not constantly decrease with the temperature rise. The stabilization of Ni-RC denoted the preference Y2O3 stabilized catalyst with average values of CH4 and CO2 conversion of about 67% and 72%, respectively. The thorough study and fine correlation will be advantageous for technologically suitable Ni-15Y-RC catalysts for DRM