AUA 2019: Update on Initial Experience with Narcotic Free Utereroscopy

Chicago, IL ( Overdoses due to opioid usage, both illicit and prescription based, were responsible for over 400,000 deaths in the United States between the years of 1997-2017. Due to this exponential increase in the severity of the opioid epidemic, the U.S. Department of Health and Human Services declared a state of emergency in attempts to begin to quell the loss of life and onset of addiction. In response to this, the state of Indiana has pioneered the pathway to reducing opioid usage via the creation of a prescription drug monitoring system known as INSPECT; if a physician fails to both update and monitor a patient’s INSPECT file prior to prescribing an opioid, it is punishable by law.

In this study, patient data between August 2017 and March 2019 was obtained and reviewed in order to evaluate the feasibility of performing narcotic free ureteroscopy (NF-URS) with the goal of no adverse effect on the workload of surgeons and staff, as well as patient satisfaction.

Participating patients were divided into two groups; narcotic free-URS (143) in which patients were prescribed Diclofenac (patients with an allergy to NSAIDs received Ultram in lieu of this), versus standard-URS (95) with commonly used narcotics. Postoperative metrics such as the number of ED visits following URS, INSPECT records, and the number of phone calls to nurses and physicians were recorded.

Between the two groups, those who were treated with standard-URS were shown to have a higher exposure to opioids, 20% of which requiring or receiving refills on their prescriptions, despite there being no difference in metrics of stone burden, size or location. In stone naïve patients, none of the NF-URS patients requested the prescription of opiates postoperatively. There remained no significant difference in stent placement or the absence of placement between the groups. After the enactment of this study, 4,261 hydrocodone tablets were precluded from use over the span of only 13 months.

This study is limited by the fact that it is retrospective and conducted at a single institution by a single surgeon; therefore, the results may not translate to all urological practices. However, this study comments upon a crucial notion that narcotic free surgery is possible and can be extended to other specialties, with no associated increase in workload or decrease in patient satisfaction.

AUA 2019 Narcotic Free Utereroscopy

Presented by: Crystal Valadon, BS, Louisville, Kentucky
Co-authors: Crystal Valadon, BS, Tim Large, MD, Julia Fluk, MD, Charles Nottingham, MD, and Amy Krambeck, MD

Written by: Courtney Cottone, Department of Urology, University of California-Irvine at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois