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

L-cysteine-mediated self-assembled Ag-Au nanoparticles as fractal patterns with bowling-alley-like hollow arrays for electrochemical sensing of dopamine

In this study, hierarchical self-assembly of Au-Ag fractal patterns with bowling-alley-like hollow arrays was achieved by a hydrothermal method using L-cysteine as an environmentally friendly reducing and stabilizing reagent. Here, free thiol groups of cysteine molecules electrostatically stabilized gold and silver nanoparticles (NPs). The plasmonic resonance red-shift of Au-Ag was confirmed from self-assembled fractal patterns that consist of micro/nano fern structures forming bowling-alley-like hollow arrays. The as-synthesized large-area hierarchical self-assembly of Au-Ag fractal patterns with the synergistic catalytic advantage of a Au and Ag NPs/glassy carbon electrode (GCE) is investigated as a potential electrochemical dopamine (DA) sensor. The biosensor based on a GCE modified with bimetallic nanoparticle fractals exhibited a reversible electrochemical behavior with limits of detection and quantification of 0.014 and 0.048 mu M, respectively. Detection of DA using the developed electrochemical sensor has several advantages, such as low cost, ease-of-use, sensitivity, and stability, that can be potentially applied for detection in a variety of chemical and biosensing applications