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

Reproductive Performance of Barki Rams Fed on Different Omega-6: Omega-3 Ratios

The current experiment intended to investigate the impact of various dietary omega- 6/ omega -3 fatty acids ratios (FAs) on the reproductive performance and  serum lipid profile  in male Barki sheep over two months' experimental period. Twelve males were randomly allotted into 4 equal groups receiving 4 different ratios of omega-6/ omega- 3 FAs including 5.40 (higher ratio, HR), 4.56 (medium ratio, MR), 3.13 (lower ratio, LR) and 1.76 (very low ratio, VLR):1.  Feeding rams on diets with HR or VLR did not exhibit substantial impact on the sperm motility, sperm viability and testosterone hormone, however these parameters were non-significantly improved in the MR and LR- fed rams. The semen volume was significantly increased (P < 0.05) with the MR in comparison with the remaining groups.  Serum biochemical parameters, including total lipids, HDL concentrations did not exhibit significant differences (P> 0.05) among the different ratios. VLR- fed rams showed the higher serum total cholesterol, triglyceride, LDL and VLDL (P< 0.05), while the MR fed rams showed the highest CHO/HDL ratio (P< 0.05) in comparison with the other ratios. In summary, Barki rams fed different omega-6/ omega- 3 PUFA ratios (5.4, 4.56, 3.13 and 1.76:1) containing diets exhibited no significant difference in their reproductive performance parameters, however the medium (4.56:1) and low (3.13:1) ratios showed potential improving effect