Enhanced Recovery After Surgery Protocol for Patients Undergoing Ureteroscopy: Prospective Evaluation of an Opioid-Free Protocol

Gridley, Chad M.; Robles, Jennifer; Calvert, Jacob; Kavoussi, Nicholas; Winkler, Taylor; Jayaram, Jennifer; Fosnot, Matthew; Liberman, Justin S.; Allen, Brian; McEvoy, Matthew D.; Herrell, Duke; Hsi, Ryan S.; Miller, Nicole L.

doi:10.1089/end.2019.0552

Cited by 60 publications

(51 citation statements)

References 20 publications

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“…In addition, Gridley et al recently implemented an Enhanced Recovery After Surgery (ERAS) protocol prospectively for patients undergoing URS. The rate of opioid prescription on discharge decreased from 93% to 0% and similarly there was no difference in postoperative calls for pain or in unscheduled encounters compared to patients discharged pre implementation of the their ERAS protocol (16).…”

Section: Discussionmentioning

confidence: 92%

Patterns of opioid prescription post ureteroscopy among members of the Endourological Society

et al. 2021

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Background: Postoperative opioid prescribing has been linked with persistent opioid use. Ureteroscopy (URS) is a common urologic procedure and a potential area to focus on opioid reduction. We aim to characterize international practice patterns of opioid prescribing post URS and what measures may decrease the need for opioid prescription. Methods:We developed a survey directed to members of the Endourological Society. The survey queried the frequency of opioid prescribing post URS, challenges when opioids are not prescribed, and measures thought to reduce the need for opioids. Results:We received 159 responses with the majority reported practicing urology for >20 years (37.1%), and performing 10-20 ureteroscopies/month (45.3%). Forty-one percent were from the United States (US) and Canada. Sixty-six percent completed a fellowship, 84% in endourology. Twenty-six percent prescribe opioids more than half the time and the majority do so less than 10% of the time (61.6%). Thirty-eight percent had no challenges when opioids were omitted. Measures felt to decrease the need for opioids were preoperative counseling, nonsteroidal anti-inflammatory drugs use, and use of adjunct medications. After adjusting for location and type of practice, endourology fellowship completion, years of practice, and number of ureteroscopies/month, we found that respondents from the US and Canada were more likely to prescribe opioids more than half the time post URS compared to respondents from the rest of the world [odds ratio (OR): 87.5, P<0.001, 95% confidence interval (CI): 17.3-443.5].Conclusions: Despite proven feasibility of non-opioid pathway, nearly one-quarter of participants in our survey prescribe opioids >50% of the time post URS. Most important factors felt to reduce opioid prescription post URS were preoperative counseling, nonsteroidal anti-inflammatory drugs use. US and Canadian urologists were more likely to prescribe opioids >50% of the time post URS compared to the rest of the world. We believe best practice guidelines should be considered by the American and Canadian Urological Associations to address post URS opioid prescribing.

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Section: Discussionmentioning

confidence: 92%

Patterns of opioid prescription post ureteroscopy among members of the Endourological Society

et al. 2021

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“…The patients receiving the non-opioid regimen received a much lower dose of morphine equivalents in the hospital and had a significantly shorter length of stay without a significant difference in pain scores (42). In the endourologic space, Gridley and associates implemented an MMA protocol for patients undergoing ureteroscopy that included pre-emptive analgesia with gabapentin and acetaminophen, intraoperative NSAID and anticholinergics, and postoperative NSAID, acetaminophen, alpha-blocking medication as well as anticholinergics (43). As compared to their conventional, opioid-based cohort, they found that patients receiving MMA had less discharge opioid prescriptions and total opioid use while observing no difference in the frequency of post-operative phone calls for pain or encounters for post-operative pain (43).…”

Section: Multimodal Analgesiamentioning

confidence: 99%

“…In the endourologic space, Gridley and associates implemented an MMA protocol for patients undergoing ureteroscopy that included pre-emptive analgesia with gabapentin and acetaminophen, intraoperative NSAID and anticholinergics, and postoperative NSAID, acetaminophen, alpha-blocking medication as well as anticholinergics (43). As compared to their conventional, opioid-based cohort, they found that patients receiving MMA had less discharge opioid prescriptions and total opioid use while observing no difference in the frequency of post-operative phone calls for pain or encounters for post-operative pain (43). These protocols employed in separate urologic subspecialties demonstrate the feasibility of managing pain using a multimodal approach as compared to a conventional, opioid-based approach.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

Enhanced recovery strategies after penile implantation: a narrative review

Ellis¹,

Sudhakar²,

Simhan³

2021

Transl Androl Urol

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Optimizing pain management strategies in penile implantation has historically been a challenge to urologists assuming care of patients post-operatively. In addition to the complex pathophysiology of male genital pain, the responsibility of opioid stewardship in the face of the ongoing narcotics epidemic presents its own set of challenges to experienced implanters. Recent innovations in pre-and intra-operative analgesia have provided some improvement in patient-reported pain outcomes. When used together in protocols spanning each phase of operative care, multimodal analgesia (MMA) regimens provide superior patient pain control and successfully decrease opioid usage compared to traditional opioid-based pain control. This review will systematically present literature that discusses interventions in the preoperative and intraoperative spaces aimed at optimally controlling pain. We will also highlight surgical techniques that have been demonstrated to help ameliorate post-operative pain in penile implant recipients. We will discuss the impact of MMA protocols across urology and further explore its larger impact on reducing opioid burden in the ongoing epidemic.

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“…An Enhanced Recovery After Surgery (ERAS) protocol was developed by Gridley et al 6 for patients undergoing ureteroscopy with a goal to minimize perioperative opioid use and have an opioid-free protocol for postoperative pain management after discharge from hospital. The ERAS protocol is summarized in Table 1.…”

Section: Analgesia: Minimizing Opioid Usementioning

confidence: 99%