Tips and tricks in achieving zero peri-operative opioid used in onco-urologic surgery

Katims, Andrew B.; Eilender, Benjamin; Pfail, John; Sim, Alan; Sfakianos, John P.

doi:10.1007/s00345-020-03305-w

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…Published pain management regimens aimed at reducing or eliminating opioid use in major and minimally invasive uro-oncologic surgery recommend gabapentin use along with acetaminophen with or without nonsteroid anti-inflammatories. 10,11 A small (N ¼ 100), randomized, doubleblind study comparing a single preoperative dose of gabapentin to placebo before a posterior urethroplasty found a significant decrease in morphine consumption in the gabapentin group. 12 The authors also found a significant difference in pain scores at 2, 4, 6, 8, 12, and 24 hours after surgery; however, a clinically significant outcome was not evident.…”

Section: Discussionmentioning

confidence: 99%

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries

Kohilakis,

Assel,

Serafin

et al. 2024

Urology Practice

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Section: Discussionmentioning

confidence: 99%

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries

Kohilakis,

Assel,

Serafin

et al. 2024

Urology Practice

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“…There are emerging non-narcotic protocols that establish several strategies that can be implemented to achieve optimal pain control and minimize narcotic usage during the pre-, intraand post-operative periods. 13 A multidisciplinary panel developed procedure specific recommendations for 16 endourological and minimally invasive urologic procedures. For all the procedures discussed, the minimum number of opioid equivalents recommended was zero.…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

Prospective evaluation of postoperative pain and opioid use after minor urologic surgery

Liu,

Moryousef,

Feng

et al. 2023

CUAJ

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Introduction: Filling an opioid prescription after a minor urologic procedure increases patient risk of overdose and misuse. Strategies to reduce the number of opioids reaching the community are critical. This study evaluates opioid use after minor urologic procedures at a Canadian academic center and guides future prescribing recommendations. Methods: We prospectively evaluated patients over 18 years old undergoing minor urologic procedures (penile, scrotal, urethral, etc.) from September 2020 to May 2022. Consenting participants were given a pain diary and postoperative pain questionnaire. Patients on chronic pain medications or those who had major surgery within six months were excluded. Response rate, pain on visual analog scale, pain control satisfaction, quantity of opioids prescribed, and consumption of opioid and non-opioid medication were collected and analyzed. Results: Ninety-five patients met the inclusion criteria. The mean age was 61.7 years (range 20–87) and 96% of patients identified as male. The response rate for the opioid diary and pain questionnaire was 57%. Forty-two patients (78%) were offered an opioid prescription following their surgery, but only 12 of those patients (22%) filled and consumed any opioids analgesics. Forty-two patients (78%) used no postoperative opioids, and the mean oral morphine equivalents (OME) consumed was 5.87 (standard deviation 16.7). There was a total of 259 OME unused from post-procedure prescriptions. The mean overall pain score for patients who did and did not fill opioid prescriptions were 3.18/10 and 1.79/10 (p<0.01), respectively, with mean overall pain management satisfaction score of 8.63/10 and 8.58/10 (p=0.94), respectively. Conclusions: Most patients undergoing minor urologic procedures do not require opioids to manage postoperative pain. Based on our data, we suggest that a prescription for 39 OME would adequately treat postoperative pain in 95% of patients undergoing minor urologic procedures. Education around pain management with non-narcotic modalities is imperative, and practice changes are warranted to address the opioid crisis within our specialty.

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“…23 Other key points to decrease opioid needs include appropriate counseling, preoperative co-analgesia (gabapentin, acetaminophen with or without nonsteroidal antiinflammatory drugs), regional or local anesthetic before incision, opioid-free protocol during surgery, and postoperative co-analgesia (ketorolac, gabapentin, and acetaminophen). 24 The Center for Disease Control also suggests reducing opioids use to 3 days or less to reduce the chance of addiction, side effects, and misuses by relatives. 8 Having a shared decision about opioid prescriptions may also play a role in diminishing opioid prescriptions.…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

Opioids use after uro-oncologic surgeries in time of opioid crisis

Turcotte

Jacques

Tremblay

et al. 2022

CUAJ

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Introduction: Recent literature emphasizes how over-prescription and lack of guidelines contribute to wide variation in opioid prescribing practices and opioid-related harms. We conducted a prospective, observational study to evaluate opioid prescriptions among uro-oncologic patients discharged following elective in-patient surgery. Methods: Patients who underwent four surgeries were included: open retropubic radical prostatectomy, robot-assisted radical prostatectomy, laparoscopic radical nephrectomy, and laparoscopic partial nephrectomy. The primary outcome was the dose of opioids used after discharge (in oral morphine equivalents [MEq]). Secondary outcomes included: opioid requirements for 80% of the patients, management of unused opioids, opioid use three months postoperative, opioid prescription refills, and guidance about opioid disposal. Results: Sixty patients were included for analysis. Patients used a mean of 30 MEq (95% confidence interval 17.8–42.2) at home and 80% of the patients used 50 MEq or less. A mean of 40.4 MEq per patient was over-prescribed. Fifty percent of the patients kept the remaining opioids at home, with only 20.0% returning them to their pharmacy. After three months, 5.0% of the patients were using opioids at least occasionally. Three patients needed a new opioid prescription. Forty percent reported having received information regarding management of unused opioids. Conclusions: We found 60% of opioids prescribed were unused, with half of our patients keeping these unused tablets at home. Our results suggest appropriate opioid prescription amounts needed for urological cancer surgery, with 80% of the patients using 50 MEq or less of morphine equivalents.

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Tips and tricks in achieving zero peri-operative opioid used in onco-urologic surgery

Cited by 8 publications

References 23 publications

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries

Prospective evaluation of postoperative pain and opioid use after minor urologic surgery

Opioids use after uro-oncologic surgeries in time of opioid crisis

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