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

Sulforaphane Downregulates Hepatic Fibroblast Growth Factor 21 (FGF21) of Diet Induced Obese Mice

Background: Fibroblast growth factor 21 is a hormone-like protein that plays a critical role as an energy regulator. Sulforaphane (SFN) is expected to have potential therapeutic effects in treating obesity. This study aims to investigate the effect of SFN treatment on hepatic gene expression of FGF-21 of diet induced obese mice. Methods: CD1 male mice and two groups of lean and diet induced obesity (DIO) model after feeding a high fat diet were used. Afterward, both lean and DIO mice were treated for four weeks with either SFN (5mg/kg BW) (n=10) or Vehicle (n=10). After that, blood and liver samples were collected and analyzed. Hepatic FGF-21 gene expression was measured using qRT-PCR. Results: Treatment of DIO mice with SFN causes a significant reduction in body weight gain (15.42%) compared to DIO-vehicle group, which showed a weight gain by (3.86%), p-value<0.0001. In addition, SFN treatment to lean group did not affect body weight. DIO-SFN treated mice showed a significant reduction in fasting glucose, leptin, and insulin levels compared to DIO-vehicle treated group, p-value<0.05. Hepatic FGF-21 gene expression was significantly upregulated in DIO-vehicle compared to lean-vehicle mice with ˜ 3 folds, p-value<0.05. Treatment of DIO with SFN causes a significant downregulation of FGF-21 gene expression by ˜9 folds compared with DIO-vehicle treated group, p-value<0.05. Conclusions: Treatment of DIO mice with SFN causes downregulation of hepatic FGF21 expression in obese mice. The effects of SFN on FGF21 gene expression could be a direct effect or secondary to weight loss, which warrants further studies.QNRF, NPRP 9 -351-3-07