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

High-Energy Ball Milling for High Productivity of Nanobiochar from Oil Palm Biomass

The current production method of nanobiochar (NBC), an emerging, environmentally friendly nanocarbon material, is tedious and lengthy. Therefore, in this study we aimed to improve the productivity of NBC via high-energy ball milling by manipulating the grinding media and processing time. The particle size distribution of the resulting NBC measured using dynamic light scattering showed that grinding media with steel balls of different sizes were more effective at producing NBC than small uniform steel balls, which failed to produce NBC even after 90 min of milling. Average NBC particles of around 95 nm were achieved after only 30 min of ball milling, and the size was further reduced to about 30 nm when the milling was prolonged to 150 min. Further prolonging the milling duration led to agglomeration, which increased the size of the biochar nanoparticles. The thermogravimetric analysis (TGA) data showed that the duration of milling and particle size did not cause noticeable differences in the thermal stability of the NBC. Based on the FTIR analysis, the chemical structure of the NBC was not affected by the ball milling. The results showed that 60 min of high-energy ball milling is sufficient to produce NBC particles of 75 nm, with a large surface area and high thermal stability. This could prove beneficial in a myriad of applications, ranging from agriculture to composite fabrication

Combined Effects of Cellulose Nanofiber Nucleation and Maleated Polylactic Acid Compatibilization on the Crystallization Kinetic and Mechanical Properties of Polylactic Acid Nanocomposite

This work investigated the combined effects of CNF nucleation (3 wt.%) and PLA-g-MA compatibilization at different loadings (1–4 wt.%) on the crystallization kinetics and mechanical properties of polylactic acid (PLA). A crystallization kinetics study was done through isothermal and non-isothermal crystallization kinetics using differential scanning calorimetry (DSC) analysis. It was shown that PLA-g-MA had some effect on nucleation as exhibited by the value of crystallization half time and crystallization rate of the PLA/PLA-g-MA, which were increased by 180% and 172%, respectively, as compared to neat PLA when isothermally melt crystallized at 100 °C. Nevertheless, the presence of PLA-g-MA in PLA/PLA-g-MA/CNF3 nanocomposites did not improve the crystallization rate compared to that of uncompatibilized PLA/CNF3. Tensile strength was reduced with the increased amount of PLA-g-MA. Contrarily, Young’s modulus values showed drastic increment compared to the neat PLA, showing that the addition of the PLA-g-MA contributed to the rigidity of the PLA nanocomposites. Overall, it can be concluded that PLA/CNF nanocomposite has good performance, whereby the addition of PLA-g-MA in PLA/CNF may not be necessary for improving both the crystallization kinetics and tensile strength. The addition of PLA-g-MA may be needed to produce rigid nanocomposites; nevertheless, in this case, the crystallization rate of the material needs to be compromised

High-energy ball milling for high productivity of nanobiochar from oil palm biomass

The current production method of nanobiochar (NBC), an emerging, environmentally friendly nanocarbon material, is tedious and lengthy. Therefore, in this study we aimed to improve the productivity of NBC via high-energy ball milling by manipulating the grinding media and processing time. The particle size distribution of the resulting NBC measured using dynamic light scattering showed that grinding media with steel balls of different sizes were more effective at producing NBC than small uniform steel balls, which failed to produce NBC even after 90 min of milling. Average NBC particles of around 95 nm were achieved after only 30 min of ball milling, and the size was further reduced to about 30 nm when the milling was prolonged to 150 min. Further prolonging the milling duration led to agglomeration, which increased the size of the biochar nanoparticles. The thermogravimetric analysis (TGA) data showed that the duration of milling and particle size did not cause noticeable differences in the thermal stability of the NBC. Based on the FTIR analysis, the chemical structure of the NBC was not affected by the ball milling. The results showed that 60 min of high-energy ball milling is sufficient to produce NBC particles of 75 nm, with a large surface area and high thermal stability. This could prove beneficial in a myriad of applications, ranging from agriculture to composite fabrication

Emerging application of biochar as a renewable and superior filler in polymer composites

Biochar is conventionally and widely used for soil amendment or as an adsorbent for water treatment. Nevertheless, the need for transition to renewable materials has resulted in an expansion of biochar for use as a filler for polymer composites. The aim is to enhance the physical, chemical, mechanical and rheological properties of the polymer composite. The reinforcement of biochar into a polymer matrix however is still new, and limited reports are focusing on the effects of biochar towards polymer composite properties. Hence, this review highlights the unique properties of biochar and its effect on the crystallization, thermal, flammability, electrical conductivity, and mechanical properties of polymer composites. This review does not solely summarize recent studies on biochar–polymer-based composites, but also offers insights into a new direction of biochar as a renewable and superior polymer filler in the future