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

A Nuclear Magnetic Resonance Study of Hydrated Systems Using the Frequency Dependence of the Relaxation Processes

A practical method is described for determining some characteristics of the spectrum of proton mobilities in a hydrated system from the frequency dependence of the nuclear magnetic resonance (NMR) relaxation processes. The technique is applied to water in association with agarose and gelatin. The results for agarose are consistent with the hypothesis that a fraction of the protons is distributed over states of reduced mobility and exchanges rapidly with the remaining fraction which is attributed to water in the normal state. No variation in the characteristics of the modified fraction could be detected for water concentrations in the range 1.2-50 g H(2)O/g agarose. Within the modified fraction, higher mobilities are more common than low mobilities; at 1.2 g H(2)O/g agarose, not more than 10% of the proton population has mobilities more than 100 times smaller than normal. The modified proton fraction is tentatively identified with agarose hydroxyl protons and possibly water molecules bound to the polymer. Proton states with mobilities intermediate between water and ice have also been detected in hydrated gelatin. As in agarose, higher mobilities are the most common. In contrast to agarose, the characteristics of the modified proton states are markedly dependent on water concentration. They are tentatively attributed to gelatin protons coupled for spinlattice relaxation with those of the bulk phase by exchange and spin diffusion

Water and Ions in Muscles and Model Systems

The nuclear magnetic reasonance (NMR) relaxation times of protons in toad muscle water have been measured at three frequencies: 2.3, 8.9, and 30 MHz. The results are analyzed in terms of a distribution of correlation times, and it is found that only a few percent of the observed protons have mobilities more than two orders of magnitude smaller than normal. Sodium and chloride ion chemical potentials in some hydrated materials with similar proton NMR characteristics to toad muscle have been found to be heightened, but not sufficiently to account for the distribution of sodium ions in muscle

Evaluation of Open-Source LP Optimization Codes in Solving Electricity Spot Market Optimization Problems

ABSTRACT. The purpose of this paper is to provide an evaluation of the three open-source LP optimization codes, GLPK, COIN-LP (CLP) and LPSOLVE in solving electricity spot market optimization problems. The paper describes a technique for automatically generating over 100 locational marginal pricing (LMP) electricity spot market optimization problems, each being solved using the three optimization codes. Performance measures were then constructed using measurements of the CPU time spent in solving each optimization problem and the CPU time spent in each optimization code’s interface. These measurements were used as the basis for performance characteristics for comparing the relative merits of each optimization code