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

Assessing the Implementation of Best Productivity Practices in Maintenance Activities, Shutdowns, and Turnarounds of Petrochemical Plants

This paper describes the development of a method to assess the level of implementation of best productivity practices in the petrochemical industry. The proposed methodology focuses on construction, maintenance activities, shutdowns, and turnarounds. Its novelty and importance are emphasized by the lack of productivity studies that target these types of projects. This article reports the research methodology steps including tool development and detailed case study assessments of projects in Singapore. The approach involved the verification of best productivity practices and the development of an assessment method designed to fit the characteristics of petrochemical projects. The assessment points out productivity practices with low implementation levels and provides recommendations to increase their usage. The results showed that the level of implementation of productivity practices in the petrochemical projects investigated was 68.42%, out of a maximum score of 100%. Practices related to Material Management and Equipment Logistics received the lowest scores and recommendations on how to bridge this productivity practice implementation gap were provided. The adoption of the Best Productivity Practices Implementation Index (BPPII) as a Productivity management tool will help the petrochemical plants to improve productivity in their projects and to be resilient during the pre-planning phase. This should also allow the petrochemical industry to attract more investments and remain competitive in order to be sustainable. The identification and analysis of practices related to maintenance activities, shutdowns, and turnarounds of petrochemical plants will significantly contribute to the body of knowledge on best productivity practice

Bacteria activate sensory neurons that modulate pain and inflammation

<p>Nociceptor sensory neurons are specialized to detect potentially damaging stimuli, protecting the organism by initiating the sensation of pain and eliciting defensive behaviours. Bacterial infections produce pain by unknown molecular mechanisms, although they are presumed to be secondary to immune activation. Here we demonstrate that bacteria directly activate nociceptors, and that the immune response mediated through TLR2, MyD88, T cells, B cells, and neutrophils and monocytes is not necessary for Staphylococcus aureus-induced pain in mice. Mechanical and thermal hyperalgesia in mice is correlated with live bacterial load rather than tissue swelling or immune activation. Bacteria induce calcium flux and action potentials in nociceptor neurons, in part via bacterial N-formylated peptides and the pore-forming toxin alpha-haemolysin, through distinct mechanisms. Specific ablation of Nav1.8-lineage neurons, which include nociceptors, abrogated pain during bacterial infection, but concurrently increased local immune infiltration and lymphadenopathy of the draining lymph node. Thus, bacterial pathogens produce pain by directly activating sensory neurons that modulate inflammation, an unsuspected role for the nervous systemin host-pathogen interactions.</p>