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

Effect of Climate Change on Polyphenols Accumulation in Grapevine

Phenolics compounds in grapes contribute to berry and must color, organoleptic properties, nutritional value, antioxidant properties and provide protection against environmental challenges. Climate change has place mammoth challenges for the viticulture industry in different viticulture regions. Environmental variables determine to the greater extent, suitable grapes varieties for fresh as well as premium quality wine production. Grape berry composition is particularly affected by heat, drought, and intensity of solar irradiation. It is expected that climatic extremes will have an adverse effect on berry quality traits such as phenolic compounds in different grape cultivars. Polyphenols particularly anthocyanins decrease at elevated temperature, similarly flavanols levels increase with better exposure to solar radiation. Water availability is crucial for better vine growth and good production, however modest water stress particularly near veraison, upregulates the activity of key enzymes of the phenylpropanoid and flavonoid pathways. Therefore, it is important to know that how and when phenolic substance accumulate in berries and how various cultivars respond. This review elaborates the effect of weather conditions on biosynthesis of different phenolic compounds in grapes. Berry phenolic substances e.g., total phenolic compounds (TPC), total anthocyanins (TAC) and total flavonoid contents (TFC) synthesis is strongly regulated under the influence of environmental conditions during growing season. In this chapter we, shall focus on accumulation of phenolic compounds in grapevine in relation to climatic variations