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

Biogenic nanoparticles application in agriculture for ROS mitigation and abiotic stress tolerance: A review

Plants have to face different abiotic stressors, such as extreme temperatures, drought, salinity, flood, and heavy metals, which negatively impact their growth and development, leading to lower agricultural productivity, food security concerns, and financial losses. Nanotechnology has emerged as a solution to mitigate these negative effects, improving resource use efficiency, reducing pollution, preventing plant diseases, and enhancing sustainability. Nanoparticles (NPs) apllication to agricultural crops addresses nutrient deficiencies, enhances stress tolerance, and improves crop yield and quality. Sustainable and environment friendly methods for synthesizing NPs have been developed over the last few decades. NPs possess distinct qualities and can serve as powerful sensors, controlling critical physiological and biochemical processes in plants. Furthermore, NPs offer unique mechanisms for adapting to changing climatic conditions. Abiotic stress generates reactive oxygen species (ROS), which cause oxidative stress and impairs redox homeostasis. The roles of ROS in signaling cascades and stress tolerance are gaining recognition. This review explores the potential of plant-based metallic and metallic oxide NPs to mitigate the harmful consequences of abiotic stresses induced excessive ROS. We have critically discussed green/biological synthesis methods of NPs, their potential roles in agriculture, and the mechanisms by which plant-based NPs can counteract ROS harmful effects on plant metabolism. Utilizing nanotechnology paves the way for sustainable crop cultivation, ensuring increased crop yields and enhanced environmental resilience