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

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Noise In Fundamental And Harmonic Modelocked Semiconductor Lasers: Experiments And Simulations

Electric-field correlation measurements of fundamental and harmonic modelocked external cavity semiconductor lasers are presented. Based on these results, an empirical model of a harmonic modelocked pulsetrain is constructed. Using this model, the equivalence between the time-interleaved pulsetrains picture and the supermode picture of a harmonic modelocked pulsetrain is shown. Simulations based on the model are presented showing the key characteristics of modelocked pulsetrains in radio frequency (RF) and optical domains. The fundamental relationship between longitudinal mode linewidth and RF phase-noise corner frequency is delineated. The generated results point to fundamental limitations in timing jitter in modelocked lasers

Toward A Photonic Arbitrary Waveform Generator Using A Modelocked External Cavity Semiconductor Laser

We propose an architecture for photonic arbitrary waveform generation where the phase-locked longitudinal modes of a 12.4-GHz fundamentally modelocked external cavity semiconductor laser are individually modulated. We report photonic synthesis of microwave tones at 37.2 GHz (limited by photodetector bandwidth) with linewidth \u3c100 Hz and dynamic range 50 dB at 100-Hz resolution bandwidth. We show photonically synthesized 12.4-GHz sine waves with superimposed sinusoidal and pulsed RF modulations, demonstrating the potential for photonic arbitrary waveform generation with the proposed architecture

High-Quality Photonic Sampling Streams From A Semiconductor Diode Ring Laser

We report on the development of an ultralow-noise, external-cavity, actively mode-locked semiconductor diode laser for application in next-generation photonic sampling systems. A summary of harmonically mode-locked noise characteristics in a 65-MHz ring cavity is presented through the range of pulse repetition frequencies between 130 MHz and 8.3 GHz (2nd-128th harmonic). Important implications regarding the use of gain-versus-loss modulation as the active modelocking mechanisms are discussed. We also report what are, to our knowledge, the lowest noise characteristics achieved to date for a semiconductor diode laser operating at 10 GHz. Individually optimized results of 0.12% rms amplitude noise (10 Hz-10 MHz), and 43 fs rms residual phase jitter (10 Hz-10 MHz) provide a theoretical resolution of 8.6 bits in a 10-GSPS optical analog-to-digital converter. We have also achieved dispersion-compensated pulsewidths as short as 1.2 ps, and shown successful operation of a novel phase-locked-loop capable of reducing the rms residual phase noise by as much as 91% within its response bandwidth. Finally, the first measurements of residual phase noise out to the Nyquist frequency (5 GHz) are presented, providing an upper bound on the rms residual phase jitter of 121 fs (10 Hz-5 GHz)

Comparison Of Fundamental And Harmonic Modelocking Of A 10 Ghz External Cavity Semiconductor Laser

We report the measurement of electric field correlations of a hybridly modelocked external linear cavity semiconductor laser as a function pulse delay. We also report the measurement of residual phase noise corner frequency and longitudinal mode linewidth as a function of laser cavity length. We find that the pulses in the modelocked pulsetrain are correlated at only multiples of the cavity roundtrip time. Excellent agreement between residual phase noise corner frequency and longitudinal mode linewidth measurements suggest that the corner frequency is the average longitudinal mode linewidth. This relationship leads to a fundamental limit in the timing jitter of modelocked lasers

Modelocked External Cavity Semiconductor Laser For Applications In Photonic Arbitrary Waveform Generation And Photonic Synthesis

A photonic arbitrary waveform generator (PAWG) that has potential for photonic arbitrary waveform generation through modulation of individual channels before recombining them is proposed. The concept of this scheme relies on the fact that modelocked lasers produce a periodic comb of phase-locked longitudinal modes