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

Low-cost adsorbent prepared from poplar sawdust for removal of disperse orange 30 dye from aqueous solutions

WOS: 000457290400023In this study, the applicability of char generated from poplar sawdust as an inexpensive adsorbent for the removal of a textile dye is investigated. Adsorbent samples were generated through pyrolysis at temperatures of 500, 600, 700 and 800 degrees C. The structural features of the char samples were illuminated by elemental analyses, FTIR, BET and SEM analyses. The effect of operating parameters such as initial dye concentration, pH and temperature were investigated and optimal values extracted. The adsorbent generated at 800 degrees C showed maximum adsorption efficiency of 83.4% at operating condition of pH 2, initial dye concentration of 50ppm and temperature of 67 degrees C. We experimentally obtained equilibrium isotherms for the adsorption of the dye. The results were modeled using Langmuir, Freundlich and the Redlich-Peterson equations with corresponding parameters being determined. The mechanism was better represented by the Redlich-Peterson isotherm