AUA 2018: The Feasibility of Discharging Patients Without Opioids After Ureteroscopy

San Francisco, CA USA ( David Sobel, MD, a clinical urologist from the University of Vermont Medical Center, presented on a study that was aimed at determining the feasibility of a non-opioid protocol for post-operative pain and stent symptoms after ureteroscopy (URS). The American opioid epidemic is a healthcare crisis, and urologist may play a role in reducing this problem by minimizing the use of opioids after minor urologic procedures.

In this study, a retrospective chart from November 2016 to March 2018 review on 206 patient was performed. Concerted efforts were made to discharge patients without opioid medications after URS. Patients were selected based on a treatment algorithm, which included no history of CDK stage II or greater, prior URS requiring opioid pain medications, and no current of prior opioid tolerance. Appropriately selected patients were discharged with either no opioid pain medications or prescribed diclofenac, an NSAID. If patients presented with any of the listed criteria, they were prescribed the standard of care opioid medication. Outcomes measured to determine feasibility were emergency department visits post-operatively, clinic telephone calls for worrisome stent symptoms, and pain medication refill requests.

Following the analysis, it was found that 151/206 (73%) of patients could be discharged without opioids. Among those, 129 received diclofenac and 22 received no pain medication. There was no difference between the opioid group and the non-opioid group on outpatient visits to the emergency department. Non-opioid groups also made fewer telephone calls to the clinic pertaining to worrisome stent symptoms and fewer requests for refill medications. However, subgroup analysis showed that BMI, chronic kidney disease and fibromyalgia were independent significant cofactors for receiving opioid medications.

In conclusion, Dr. David Sobel reiterates that nearly three quarters of patients could be discharged without opioids after undergoing URS and stent placement, as long as they were properly selected for. This pilot study shows the feasibility of patient discharge after URS without opioids and Dr. David Sobel encourages all urologists to consider non-opioid treatment post-procedure.

Presented by: David Sobel, MD

Written by: Whitney Zhang, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA