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

Spiral Groove Bearing Multiphysics Modeling

Cone crushers are widely used in the mining, mineral processing and quarrying segments of the industry to crush ores and large rocks. In such machinery, the load to be carried is rather heavy and the motion is gyratory which creates a need for a bearing set that can withstand such severe conditions. Sandvik AB is a high-technology Swedish engineering group specialized in tools and tooling systems for metal cutting, equipment, as well as tools and services for the mining and construction industries. One of their products relevant to the mining industry is the cone crusher which utilizes a 3-piece bearing set to carry thrust load. This bearing can be classified as a Spiral Groove Bearing \footnote{The abbreviation S.G.B will be used interchangeably throughout the thesis.}, and it has been incurred that it wears out rather quickly and is believed to be running under mixed-lubrication conditions where the interfaces in the bearing-set are not fully lubricated. The aim behind this thesis is to create a multiphysics model of this bearing in order to understand deeply how it works and the reasons why it does not perform as expected as well as to predict design improvements which can improve the performance of the bearing-set, thus increasing its operating life. It has been concluded that the bearing operates under severe mixed-lubrication conditions and that the generation of a squeeze film is the only method by which lubrication takes place due to the excessive depth of the grooves which is needed to allow for an adequate amount of cold oil to flow into the grooves and cool the interface as well as to accommodate for a considerable amount of wear particles. In light of the results and insight gathered from the simulations, possible design variations of the bearing which can be advantageous in terms of mitigating asperity friction in the interfaces of the bearing are discussed and tested