Opioid prescribing for acute postoperative pain: an overview of systematic reviews related to two consensus statements relevant at patient, prescriber, system and public health levels.

BACKGROUND: National guidelines for rational opioid prescribing for acute postoperative pain are needed to optimise postoperative pain control and function whilst minimising opioid-related harm. OBJECTIVES: This overview of systematic reviews aims to summarise and critically assess the quality of systematic reviews related to the 20 recommendations from two previously published consensus guideline papers (ten relevant at patient and prescriber levels and ten at a system / Public Health level). It also aims to identify gaps in research that require further efforts to fill these in order to augment the evidence behind creating national guidelines for rational opioid prescribing for acute postoperative pain. METHODS: A systematic database search using PubMed/MEDLINE and Cochrane was conducted in November 2022. Furthermore, reference lists were reviewed. All identified systematic reviews were assessed for eligibility. Data from each study was extracted using a pre-standardised data extraction form. The methodological quality of the included reviews was assessed by two independent reviewers using the AMSTAR 2 checklist. Descriptive synthesis of the results was performed. RESULTS: A total of 12 papers were eligible for analysis. Only eight out of the total 20 prioritised recommendations had systematic reviews that provided evidence related to them. These systematic reviews were most commonly of critically low quality. CONCLUSION: The consensus papers provide guidance and recommendations based on the consensus of expert opinion that is based on the best available evidence. However, there is a lack of evidence supporting many of these consensus statements. Efforts to further analyse interventions that aim to reduce the rates of opioid prescribing and their adverse effects should therefore continue.

Short communication: analysis of health and survival in a population of Ontario Holstein heifer calves.

The objective of the present study was to investigate health and survival in heifer calves, from 16 farms in southwestern Ontario. Research technicians visited the farms on a weekly schedule for 16 mo, starting in January 2008, and collected blood samples and various measurements to determine the overall health status of the calves. Data of 1,588 Holstein heifer calves from birth until 90 to 120 d of age were analyzed. Initially, a survival analysis was carried out to determine which factors surrounding birth increased a calf's risk of mortality. The factors examined were type of birth, calving ease, season of birth, serum total protein, weight during first week of life, treatment status during first week of life, total number of treatments, and bovine respiratory disease status. In general, calves born in fall (October-December), low serum total protein, low weight, and calves treated for illness during the first week of life, increasing number of treatments, and being treated for bovine respiratory disease all increased a calf's risk of mortality. Genetic parameters for requiring treatment for illness, survival, bovine respiratory disease, other diseases, height, and weight were estimated. Heritabilities for treatment, survival, and diseases were low, ranging from 0.04 to 0.07, and were not significant. Moderate and significant heritabilities were found for height (0.33 to 0.45) and weight (0.24 to 0.44). Treatment and survival to 90 to 120 d of age were favorably correlated, indicating that calves requiring less treatment have a higher survival rate and vice versa. Further, body weight was found to have a tendency of favorable genetic correlation (-0.22 to -0.53) with treatment for diseases, indicating that calves with higher body weight in their first month of life were genetically more resistant to diseases than those with average body weight. Overall, our results show the potential of using data on calfhood disease and survival in future dairy cattle breeding programs. Further investigation and improved data collection are required to determine the full impact of genetics on health and survival in dairy heifer calves.

Identification of polymorphisms in the malic enzyme 1, NADP(+)-dependent, cytosolic and nuclear receptor subfamily 0, group B, member 2 genes and their associations with meat and carcass quality traits in commercial Angus cattle.

Genes involved in the physiological control of energy and triglyceride synthesis, such as malic enzyme 1, NADP(+)-dependent, cytosolic (ME1) and nuclear receptor subfamily 0, group B, member 2 (NR0B2), are key candidates that may have effects on meat and carcass quality traits. These genes were sequenced in Aberdeen Angus beef cattle, and the possibility of associations between SNPs and economically important carcass and meat quality traits was tested. Six novel SNPs, five in ME1 and one in NR0B2, were identified. A SNP in exon eight of ME1 resulted in a non-synonymous amino acid change from valine to isoleucine. Phenotypic data were recorded on 536 commercial Aberdeen Angus-cross beef cattle, which comprised 28 carcass quality, tenderness and sensory traits. The majority of the SNPs were associated with at least one of these traits, including an association between the NR0B2 SNP and fat class, and associations between at least one of the ME1 SNPs and eye muscle area, sirloin weight before maturation, sirloin steak tail length, and juiciness.

Associations between the 11-bp deletion in the myostatin gene and carcass quality in Angus-sired cattle.

An 11-bp deletion in the bovine myostatin (MSTN) gene was identified as the causative mutation for the double-muscling phenotype in Belgian Blue and Asturiana cattle. More recently, this mutation was also identified in the South Devon breed of cattle, in which it has been found to be associated with a general increase in muscle mass. The present study found that the mutant allele was also segregating in a commercial population of Scottish Aberdeen Angus beef cattle. The mutation was found at a low frequency (0.04) with no animals homozygous for the mutation in the sample population (536 animals). The effects of this mutation on various carcass traits of economic interest were then tested. We found that the mutation significantly increased carcass weight, sirloin weight, hindquarter weight, muscle conformation score and eye muscle area, but had no effect on the fat traits.

Similar improvements in reproductive performance of male line, female line and parent stock broiler breeders genetically selected in the UK or in South America.

1. Field data on the reproductive performance of parent stock and grandparent female line and male line broiler breeders were extracted from a commercial database covering the years of hatch from 1989 to 2002. The data were from the UK, Western Europe, Central and South America and Japan. Quadratic regression curves were fitted to the data to estimate the long-term phenotypic trends in total egg production, hatching egg production, chick numbers, hatchability and female mortality. 2. Changes in performance over time were similar in the UK, Western Europe and Central and South America and are consistent with the suggestion that genetic selection in separate breeding programmes in the UK (supplying the UK and Western Europe) and Brazil (serving Central and South America) was associated with similar improvements in the performance of commercial parent stock and grandparent flocks. Changes in performance in Japan (supplied from the UK) were different but recent performance was similar to those in the other regions. 3. The mean annual improvements over 10 years to 2002 for male line, female line and parent stock, respectively, were 0.4, 1.7 and 1.7 for total egg number; 0.5, 1.8 and 1.6 for hatching egg number; 0.6, 1.8 and 1.3 for total chick production; 0.25, 0.47 and 0.09% for hatchability; and -0.69, -0.05 and -0.41% for female mortality. 4. The results are consistent with claims that significant genetic change in pedigree selection (nucleus) flocks by the primary breeding company are reflected in substantial improvements in reproductive performance in commercial flocks. The presence of similar rates of improvement in different geographical regions as a result of genetic selection in two continents representing tropical and temperate regions suggests that genotype-environment interactions for reproduction traits are not important.

Pecking at other birds and at string enrichment devices by adult laying hens.

1. Bunches of white string (polypropylene twine) are particularly attractive pecking stimuli for both chicks and adult laying hens. Furthermore, these devices can retain the birds' interest over lengthy periods. It has also been demonstrated that birds with trimmed feathers elicit feather pecking. The present study was designed to determine whether string devices would retain their attractiveness in the presence of a competing stimulus: a trimmed hen. 2. Lohmann Brown hens were reared in 20 groups of 5 in floor pens with perches from 17 weeks of age. They were exposed to one of two treatments when they were 23 weeks old. One hen was removed from every pen and the feathers on her rump were trimmed. Immediately before her return two string devices were suspended from a perch in treatment 1 whereas no devices were included in treatment 2. Pecking behaviours were immediately observed for 30 min; this procedure was repeated later that day. The devices remained in the pens used in treatment 1 and these birds were observed again for 15 min after 14 d. 3. The string devices were pecked earlier and more than either the trimmed or untrimmed hens. Furthermore, the devices were still being pecked 2 weeks after their introduction. 4. The virtual absence of severe feather pecking and of aggressive head pecks precluded test of our hypothesis that the devices would divert potentially injurious pecking away from other birds. However, the fact that the birds showed sustained interest in the devices, even in the presence of a competing stimulus, supports our proposal that string may represent a practicable and effective form of environmental enrichment.

Embryo development and establishment of pregnancy after embryo transfer in pigs: coping with limitations in the availability of viable embryos.

Embryo transfer and pregnancy maintenance strategies in pigs were evaluated with reference to situations in which limited numbers of viable embryos or micromanipulated embryos are available, such as pig cloning. Development of embryos with compromised zona pellucida was compared with development of embryos with intact zona pellucida. Micromanipulation had no effect on blastocyst production rates after development in vivo or in vitro, but development in vivo improved the number of embryos reaching the blastocyst stage. Transfer of embryos with compromised zona pellucida resulted in live piglets. Several hormone treatments to maintain pregnancy were tested in a model in which three embryos were transferred into unmated recipient gilts, compared with transfer of three embryos into mated recipients. None of the hormonal treatments resulted in pregnancy rates of more than 25% at term and no more than 9% of transferred embryos survived, in comparison with 50% of the mated recipients successfully carrying 25% of transferred embryos. Lastly, the developmental potential of parthenogenetic embryos was assessed and 62% of transferred embryos resulted in pregnancies, none of which continued beyond day 55 of gestation. After co-transfer of three fertilized embryos with 55-60 parthenogenetic embryos into each of six recipients, two live piglets were delivered. The results from the present study indicate that transfer of zona pellucida compromised embryos can yield litters of normal piglets. In addition, it was demonstrated in a model system involving the transfer of three fertilized embryos into mature gilts that hormonal pregnancy maintenance strategies support a low proportion of embryos to term. Lastly, the present study shows for the first time a comparably effective but novel alternative for pregnancy maintenance in the pig involving the co-transfer of parthenote embryos.

Gait analysis of poultry.

Lameness is a major problem in the UK poultry industry, however, relatively few objective studies have been undertaken into the biomechanics of normal walking in these birds. In this study, the use of a pedobarograph as a novel method of gait analysis in poultry was investigated. Unlike most systems, the pedobarograph has a recording surface with a high degree of spatial resolution, allowing pressure patterns to be established for various regions of the foot. The highest pressures were found to act on the medial toe (149.4-218 kN m(-2)) and back toe (146.1-195.5 kN m(-2)). The metatarsal pad, a region often associated with lesions, was subject to lower pressures (16.3-131.2 kN m(-2)). Maximum net forces of 116-145 per cent of bodyweight were found during normal walking, an order of the same magnitude as human bipeds. Routine spatial parameters were also measured, allowing further characterisation of the gait patterns.

Studies on effects of nutritional factors on bone structure and osteoporosis in laying hens.

1. A modern hybrid strain of laying hen (Hisex) was fed from point of lay to 68 weeks on a control diet and diets containing oystershell, fluoride, 1,25-dihydroxycholecalciferol, ascorbic acid, a lower concentration of phosphorus and a combination of a lower concentration of crude protein and higher concentration of vitamin K. Hens from a much older strain (Brown Leghorn J-line) were fed on the control diet. 2. Plasma variables were measured during lay. End-of-lay trabecular and medullary bone volumes in the proximal tarsometatarsus and free thoracic vertebra were measured by histomorphometry. 3. The majority of Hisex hens were considered to be osteoporotic by the end of lay. In contrast, none of the J-line were osteoporotic. 4. None of the nutritional treatments affected trabecular bone volumes. Medullary bone volumes were increased significantly by feeding oystershell or fluoride. 5. There was no phenotypic correlation between egg production and trabecular bone volume in the Hisex hens. 6. The experiment provided evidence that osteoporosis in laying hens, as assessed by trabecular bone volumes, is not caused by calcium deficiency and could not be prevented by any of the nutritional treatments studied.

Utilisation of U-14C-lysine by young turkeys.

1. U-14C-lysine was administered by tube into the crop to turkey poults fed on assay diets (maize + sesame + maize gluten meal) containing varying concentrations of lysine, and partition of the label into body components, carbon dioxide, and excreta was measured. 2. Deposition of 14C label into breast and heart muscles responded positively to dietary lysine concentration. There was no apparent relationship between dietary lysine intake and deposition of label into carbon dioxide or excreta. 3. Efficiency of lysine retention, above maintenance, was estimated to be 0.523 +/- 0.034. 4. Turkeys exhibited variable metabolic efficiency in the use of lysine as indicated by loss of U-14C-lysine label to expired carbon dioxide and to excreta by individual turkeys.

Identification of tissue hypoxia in the livers of ascitic and hypoxia-induced broilers using trypan blue.

1. The perfusion of livers with the vital dye trypan blue was performed to test for evidence of tissue hypoxia in 3 groups of young broiler chickens, namely, ascitic, hypoxia-induced and controls. 2. Hepatocytes that stained with trypan blue were considered to be dead or dying before fixation and represented damaged cells. 3. The proportion of trypan blue-stained hepatocytes in the livers of ascitic birds was slightly less than half that observed in the hypoxia-induced birds but significantly more than the proportion of stained cells observed in control birds. 4. Liver damage in the ascitic birds was also assessed biochemically by an altered enzyme profile. 5. The study demonstrated that increased trypan blue uptake in the livers of ascitic birds reared at sea-level may be the consequence of hypoxia stress caused by reduced oxygen utilisation.

Effects of long-term food restriction on energy expenditure and thermoregulation in broiler-breeder fowls (Gallus domesticus).

1. From 2 to 21 weeks of age, 150 female broiler-breeder chicks received one of three dietary treatments. Fifty received an ad libitum supply of food (treatment AL). The remaining 100 were given weighed (restricted) rations once a day, 50 receiving the amount per bird recommended in the Ross 1 Parent Stock Management Manual (treatment R) and the other 50 receiving twice this recommended amount (treatment 2R). Water was provided ad libitum for all treatment groups. 2. The daily allowance for R birds increased from 26 g per bird at 2 weeks of age to 94 g at 21 weeks. The intake of AL birds meanwhile increased from 65 g at 2 weeks to 240 g at 19 weeks, before decreasing to about 200 g at 21 weeks. 3. Median heat productions (H) per bird in the R and 2R treatment groups were, respectively, 65 and 40% lower than in the AL when adjustment was made for the reduced food intake of AL birds in the calorimeter chambers. The effects of dietary treatment on fasting H were proportionally similar. 4. Because the increasing divergence in body weights would have made a large contribution to differences in H per bird, the results were adjusted to the median weight of 2.03 kg and to unit weight (1.00 kg). Adjusted fasting heat production was 18 and 11% less in 2R and R birds than in those fed ad libitum.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of proanthocyanidin-rich bean hulls and level of dietary protein on energy metabolizability and nutrient digestibility by adult cockerels.

Cotyledons and hulls were prepared from twelve varieties of field beans (Vicia faba L.). Adult cockerels were tube-fed either beans, cotyledons or hull diets containing high or low levels of protein. Metabolizable energy coefficients and starch digestibility coefficients were determined for beans, cotyledons and hull diets. Lipid digestibility coefficients from hull diets were also determined. When cotyledons were fed there were no significant differences in the way in which adult cockerels metabolized energy or digested starch from the proanthocyanidin-free and proanthocyanidin-rich varieties (0.780, 0.908, 0.775 and 0.918 respectively). When beans were fed, however, both energy metabolizability and starch digestibility decreased due to the presence of hulls, with proanthocyanidin-rich hulls decreasing values the most to 0.660 and 0.819 respectively, and proanthocyanidin-free hulls decreasing values to a lesser extent to 0.709 and 0.886 respectively. Diets composed of proanthocyanidin-rich hulls depressed metabolizable energy and maize starch digestibility. Their effect on maize starch digestibility, however, was considerably less than that on bean starch. Lipid digestibility was enhanced by proanthocyanidins but only when the protein content of the diet was high. There was a significant correlation (P < 0.05) between the vanillin and anthocyanidin formation methods for the estimation of proanthocyanidins (r 0.779). There was also a highly significant regression of bean starch digestibility v. proanthocyanidin content of coloured-flowered bean hulls (P < 0.001). The regression of maize starch digestibility v. hull proanthocyanidins was also significant at P < 0.005.

Whole blood and plasma viscosity values in normal and ascitic broiler chickens.

1. Whole blood and plasma viscosity values in normal and ascitic broiler chickens were measured. 2. The mean blood viscosity value in ascitic broilers was greater than that of the controls. There was a small but significant difference in the opposite direction between plasma viscosity values of the respective groups of birds. 3. Although the haematocrit and arterial pressure index values in the ascitic birds were raised, there was a fall in the concentration of total plasma protein. 4. The data suggest that the raised viscosity in the ascitic birds was caused by a polycythemia and not by any influence of plasma protein. 5. The cumulative effect of these factors, such as raised blood viscosity values and larger deformed red cells flowing through constricted lung arterioles, may contribute to the pulmonary hypertension and ascites seen in some young commercial broilers.

The effect of proanthocyanidin-rich hulls and proanthocyanidin extracts from bean (Vicia faba L.) hulls on nutrient digestibility and digestive enzyme activities in young chicks.

Proanthocyanidins were prepared from three bean (Vicia faba L.) varieties by extracting hulls in aqueous acetone. The amounts of freeze-dried extracts recovered were 74, 89 and 97 g/kg hull for the varieties Brunette, Statissa and Minica respectively. Chicks (3 weeks old) were fed on a maize-soya-bean control diet or the same control diet substituted with either 30 g proanthocyanidin extracts/kg or 300 g proanthocyanidin-rich hulls/kg. Chicks were tube-fed diets twice daily for 4 d. Nutrient digestibilities were calculated from amounts present in diets and freeze-dried excreta with the aid of titanium dioxide as a marker. Enzyme activities were measured in digesta removed from the jejunum. Extracts of proanthocyanidins depressed the digestibility of protein by 34%, starch by 3% and had no effect on the digestibility of lipid. Proanthocyanidin-rich hulls depressed the digestibility of protein by 62%, starch by 6% and lipid by 4%. Digestive enzyme activities were depressed to the same extent by extracts and hulls, trypsin (EC 3.4.21.4) by 55 and 62%, alpha-amylase (EC 3.2.1.1) by 75 and 78% and lipase (EC 3.1.1.3) by 31 and 32% for proanthocyanidin-extract and proanthocyanidin-rich-hull diets respectively. The susceptibility of substrates as well as enzymes to the effects of proanthocyanidins is discussed.

Comparison of haematological values in restricted- and ad libitum-fed domestic fowls: white blood cells and thrombocytes.

1. White blood cells and thrombocyte values were examined in normal domestic fowls of layer and broiler strains fed restricted or ad libitum diets. 2. Basophils were the only white blood cells to increase significantly in number after the period of food restriction. It is suggested that the increase may have been associated with stress. 3. There were more basophils in broilers than layers, in males than females and in younger than older birds. 4. In contrast, a decrease in the total number of white blood cells was seen in birds maintained on a restricted diet compared with those fed ad libitum. 5. Stress may also have been responsible for an increased thrombocyte count in the restricted birds as well as a slightly lowered eosinophil count. 6. Heterophil/lymphocyte ratios were not significantly altered by the restriction of food.

Comparison of haematological values in restricted- and ad libitum-fed domestic fowls: red blood cell characteristics.

1. A haematological study of the red blood cell characteristics in domestic fowls fed restricted and ad libitum diets was examined. The characteristics included Hb (haemoglobin), PCV (Packed Cell Volume), Rbc (Red blood cell count), MCH (Mean Cell Haemoglobin), MCV (Mean Cell Volume), MCHC (Mean Cell Haemoglobin Concentration) and reticulocytes. 2. The investigation showed that Hb, PCV, MCH and MCV were all reduced when broilers were fed a restricted diet. The number of Rbc's in these birds also increased significantly compared with control ad libitum-fed broilers. MCHC and reticulocyte numbers did not alter significantly. 3. It is proposed that some of the red cell characteristics may be restored to within "normal" ranges by food restriction. However, the results did show that there was a tendency to induce a microcytic normochromic anaemia in these restricted-fed birds.

Experimental systems which modify and simulate rapeseed-induced liver haemorrhages in in-lay hens.

The occurrence of liver haemorrhages was compared when diets containing 30 or 40 per cent rapeseed meal (RSM) or 30 per cent soybean meal (SBM), with and without experimental additives, were fed to in-lay hens of a commercial egg-producing strain for 12 weeks. The incidence of haemorrhages was significantly greater when the birds were maintained on the basal (unsupplemented) RSM diet than on the equivalent SBM diet. Haemorrhages were either small and infrequent, minute and multiple as in peliosis hepatis, or large enough to rupture the liver capsule. They might be recent or old and encapsulated, sometimes both varieties affecting the same specimen, and they occurred in any part of the liver. Histologically, hepatocyte necrosis and reticulin derangement were not detected in livers without gross haemorrhages and even in those with haemorrhages these abnormalities were only seen closely adjacent to haemorrhages or to foci of eosinophilic fibrinoid. In some instances there was sinusoidal ectasia. Separate additions of 50 g dried skimmed milk powder, 0.5 g zinc oxide, 0.25 g ferrous sulphate or 2.0 mg selenium (as sodium selenite) kg-1 to the basal RSM diet did not significantly modify the incidence of haemorrhage. Ferrous sulphate slightly reduced goitrogenicity. Supplements of 2.2 mg menadione and 1.0 g sodium phenobarbital kg-1 RSM diet induced slight reductions in the number of cases of liver haemorrhage or their severity, indicating that the multifunction oxidase system may be involved in rapeseed hepatotoxicity. The addition of 0.5 g methimazole kg-1 to the basal SBM diet induced severe colloid goitre but did not induce liver haemorrhage. Both thiouracil (0.5 g kg-1 diet) and beta-aminopropionitrile (0.5 g and 2.5 g kg-1 diet) when added to the basal SBM diet induced liver haemorrhages which did not differ in incidence or histological appearance from those induced by RSM. Hyperplastic goitre was caused by thiouracil. Intrahepatic cholestasis induced by sodium taurolithocholate, bilirubin and alpha-naphthylisothiocyanate and extrahepatic cholestasis induced by bile duct ligation resulted in hepatocyte necrosis but not gross liver haemorrhages. Spontaneous deaths due to conditions other than liver haemorrhages were significantly more numerous in RSM-fed than SBM-fed hens.(ABSTRACT TRUNCATED AT 400 WORDS)