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

The accessibility and safety of inserting proximal basilic and axillary veins central lines in neonates

Objectives: to evaluate the accessibility, success rate, and attributable complications and to describe the maneuver for central line insertion via proximal basilic or axillary veins in neonates. Methods: This retrospective study included all infants admitted to the neonatal intensive care unit and had an axillary central line inserted or attempted. Success rate, complications, and outcomes were reviewed. Results: Axillary central line was attempted in 85 infants and was successful in 78 infants with a success rate of 91.7%. The median postnatal age of patients was 8 days (2 days–92 days), and the median weight of patients at the procedure was 2600 g (590 g–3900 g). The median corrected gestational age of patients at the procedure was 36 weeks (23 weeks–46 weeks). No serious complication was observed in any of the 85 infants. Conclusion: This study demonstrated a high success rate for insertion of proximal basilic and axillary veins central lines in neonates with difficult vascular access. This procedure was feasible in very low birth and extremely low birth preterm infants, especially in those who failed previous central line attempts

Protease from Bacillus subtilis ZMS-2: Evaluation of production dynamics through Response Surface Methodology and application in leather tannery

Proteolytic enzymes are the most versatile and commercially viable group of enzymes comprising over 65% share in the global enzyme market amongst which alkaline proteases have extensive applications in detergent and leather industry. Current study was designed to assess the potential of an alkaline serine protease from Bacillus subtilis ZMS-2 as a bating agent in leather processing. Initially, the production parameters were investigated through Response Surface Methodology (RSM) using Plackett-Burman Design, which identified substrate, agitation speed and incubation temperature as the most significant factors. The optimal levels of these factors were determined through the Box-Behnken experimental analysis as 0.436% substrate concentration, 36.5 °C incubation temperature and 56 rpm agitation speed. The statistical optimization experiments increased the volumetric production of enzyme by 3.94 times (2246 U mL−1) than the initial titer (571 U mL−1). The enzyme was partially purified and characterized as metal ions and detergent compatible serine protease having optimum activity at pH 8 and 60 °C. During the pilot-scale application as a bating agent, the enzyme (340 U mL−1) successfully removed the hair roots and other unwanted proteins from goat skins as observed during scudding and confirmed through Scanning Electron Microscopy. The processed skins displayed enhanced porosity, thumb impression, smoothness and pliability. These findings provide a strong basis for the use of this protease as an efficient and eco-friendly alternative for bating of animal skins in leather tanneries