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

PENGARUH TAKARAN PUPUK FOSFOR (P) TERHADAP PERTUMBUHAN DAN HASIL BEBERAPA VARIETAS TANAMAN PADI (Oryza sativa L.)

Padi merupakan tanaman pangan yang menghasilkan makanan pokok penduduk Indonesia. Peningkatan kualitas tanaman sangatlah penting dilakukan, salah satunya melalui  pemberian Pupuk Posfor (P) dan pemilihan varietas tanaman merespon pemupukan terhadap pertumbuhan. Penelitian bertujuan untuk mengetahui pengaruh pemberian takaran pupuk P terhadap pertumbuhan dan hasil beberapa varietas tanaman padi. Penelitian dilaksanakan di lahan sawah di Desa Telukbuyung, Kecamatan Pakisjaya, kabupaten Karawang. Rancangan yang digunakan dalam penelitian adalah Rancangan Split Plot terdiri dari petak utama varietas terdiri dari empat taraf yaitu: v1 (varietas Ciherang), v2 (varietas Mekongga), v3 (varietas inpari 33), v4 (varietas Cilamaya Muncul). Anak petak takaran pupuk P (biost P) terdiri dari empat taraf yaitu: d0 (tanpa pupuk P), d1 (150 kg ha-1), d2 (300 kg ha-1), d3 (450 kg ha-1). Hasil percobaan menunjukkan terjadi interaksi antara varietas dengan takaran pupuk P terhadap bobot gabah kering panen (GKP) per rumpun. Hasil bobot gabah kering panen (GKP) per rumpun sebesar 572,60 gram diperoleh melalui varietas Mekongga dengan takaran dosis pupuk P 300 kg ha-1