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

Prophylactic and Therapeutic Efficacy of Prebiotic Supplementation against Intestinal Coccidiosis in Rabbits

This study was conducted to investigate the effect of prebiotic supplementation against intestinal coccidiosis in rabbits. Fifty male rabbits aged 35–60 days (1–1.5 kg) were divided into prophylactic and therapeutic experiments (five groups, 10 rabbits per group). Prophylactic experiment had prebiotic supplemented (PS-P), non-supplemented infected control (NI-P), and non-supplemented non-infected control (NN-P) groups. Ten days post-prebiotic supplementation (PPS), rabbits in groups PS-P and NI-P were infected orally with 5.0 × 104 sporulated oocysts of mixed Eimeria species. However, therapeutic experiment had prebiotic supplemented (PS-T) and untreated infected (UI-T) groups of naturally infected rabbits with Eimeria species. A significant reduction in oocyst count per gram feces (OPG) (p ≤ 0.05) was reported in the PS-P (57.33 × 103 ± 2.84) and NI-P (130.83 × 103 ± 43.38) groups during the experiment. Additionally, rabbits in groups (PS-P, 970.33 ± 31.79 g and NI-P, 870.66 ± 6.66 g) showed weight loss after infection. However, a significant (p ≤ 0.05) decrease in OPG was observed at day seven PPS in the PS-T group (4 × 103 ± 0.00) when compared with the UI-T group (32 × 103 ± 7.54). Furthermore, the PS-T group had a higher body weight than rabbits in the UI-T group. Histopathological findings of the intestinal tissues (duodenum, jejunum, and ileum) showed that the counts of the endogenous stages were significantly higher in the NI-P and UI-T groups than in the prebiotic-supplemented groups (PS-P and PS-T). Supplementation of the prebiotic did not have any adverse effects on biochemical parameters, such as AST, ALT, creatinine, total protein, and total cholesterol. In conclusion, prebiotic supplementation can be used to minimize the adverse effects of intestinal coccidiosis in rabbits, which in turn limits body weight loss, especially for the prophylaxis of coccidial infection