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

Evaluation of Four Commercial Sources of Synthetic Methionine on the Growth Performance, Carcass and Meat Quality of Broiler Chickens

A total of 252 day old Ross broiler chicks was used in a feeding trial to evaluate the effect of four different commercial brands of synthetic methionine supplement on the performance of broiler chickens. The chicks were distributed into four dietary treatments each with three replicates and 21 chicks/replicate; in a Completely Randomized Design. Four diets were formulated to meet standard requirements at both starter and finisher phases in which the four commercial brands of synthetic methionine; CHL Rhodimet Analogue and DSM were supplemented in diets to represent treatments 1, 2, 3 and 4, respectively. Eight weeks period of the experiment. Data was collected on feed intake weight gain feed conversion protein efficiency and feed cost/Kg gain to evaluate growth performance. Blood samples were collected at the finisher phase over EDTA and analysed for heamatological parameters. Carcass study was conducted and meat quality evaluation of cut portions of breast muscles was carried out. All data collected were subjected to Analysis of Variance and differences in means were separated using Duncan Multiple Range Test. Significant (P<0.05) differences were observed for final weight, weight gain, feed conversion ratio, feed cost/Kg gain and mortality rates but no significant (P>0.05) difference for feed consumption across the treatments at both starter and finisher phases. Birds fed with DSM Methionine has a significantly (p<0.05) higher performance in terms of weight gain and feed conversion ratio but consumed less feed and required least cost to produce a kg of broiler meat compared to other treatments. Blood quality parameters were similar for all treatments. DSM Methionine had better digestibility for all nutrients measured. There was significant (P<0.05) difference in dressed weights, dressing percentages, back, heart, liver, kidney and intestinal length but no significant (P>0.05) difference in their breast muscles, thigh, drumsticks, gizzard, lungs, abdominal fat and intestine weight. DSM Methionine showed the best dressed weight and dressing percentage. F Meat from birds fed DSM Methionine gave highest crude protein and lowest fat content. It was therefore concluded that DSM methionine is of highest quality above the other brands evaluated and is recommended for best performance and most economical broiler chicken production enterprise.Key words: Methionine, broiler chickens, performance, carcass and meat qualit

The Effect of Cinnamon Extract on Spermatogenesis and

. (2011). Haematological and serum biochemical indices of growing rabbits fed camel blood rumen content mixture

Structural, optical and elastic properties of silver oxide incorporated zinc tellurite glass system doped with Sm3+ ions

Zinc tellurite glasses in the form of [{(TeO2)0.7 (ZnO) 0.3}0.99 (Sm2O3)0.01]1-y (Ag2O) y, y = 0.005. 0.01, 0.015, 0.02 and 0.025 M fraction is prepared by the method of melt quenching. The molar volume decreases while the density of the glasses increases with an increase in dopant. The indirect and direct band gap increased with an increase in dopant content. Urbach energy, molar refraction, molar polarizability, refractive index, and electronic polarizability are shown to be decreased with an addition of silver oxide. The samples shear and longitudinal velocities are measured at room temperature of 5 MHz frequency. Poisson ratio (σ), Elastic moduli, hardness (H), Debye temperature ( ), Softening temperature ( ), bond connectivity (d) and fugacity ( ) are calculated to reveal the quantitative analysis concerning the structure of the synthesized glasses. The obtained results have revealed the adverse effect of silver oxide on the host materials by enhancing the properties and strengthening the glass network