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

Critical Home Video

This catalogue for an exhibition of British video art is comprised of 15 leaves contained in a box resembling a case for a video tape. The 12 videos in the exhibition are each represented by a card featuring one video still and a brief descriptive text. Mabb's curatorial introduction outlines the origins of this exhibition of low-budget video art from London

Exploiting pyrolysis protocols on BTDA-TDI/MDI (P84) polyimide/nanocrystalline cellulose carbon membrane for gas separations

Tubular carbon membranes were fabricated by the blending of BTDA-TDI/MDI (P84) polyimide with nanocrystalline cellulose in a controlled pyrolysis process, specifically the pyrolysis environment (He, Ar, and N2) and the thermal soak time (30–120 min). The carbon membrane layer on a tubular support is converted to carbon matrix at 800 °C with a heating rate of 3 °C min−1. The effects of these controlled pyrolysis conditions on the gas permeation properties have been investigated. The results revealed that the pyrolysis under Ar gas environment at 120 min of thermal soak time have the best gas permeation performance with the highest CO2/CH4 selectivity of 68.2 ± 3.3 and CO2 permeance of 213.6 ± 2.2 GPU. © 2018 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2019, 136, 46901