Presentation Authors: Jason Joseph*, Kevin Hebert, Jack Andrews, Matthew Ziegelmann, Elizabeth Habermann, Matthew Gettman, Boyd Viers, Rochester, MN
Introduction: The United States is facing an opioid epidemic. Surgeons play a critical role, with the incidence of chronic opioid use following surgical procedures impacting up to 10% of patients. Limited evidence exists to guide procedure-specific opioid prescribing best practices and non-opioid based care pathways. We sought to evaluate postoperative opioid requirements and evaluate efficacy of a standardized perioperative pain management pathway for men undergoing anterior urethroplasty.
Methods: Between August 2017 and October 2018, we prospectively evaluated consecutive men undergoing outpatient urethroplasty by a single surgeon. Standardized perioperative pain pathways were implemented based on urethroplasty location (penile vs. bulbar) and on need for buccal mucosa graft (Figure 1). Postoperative opioid usage, amount of unused opioid, pain scores (Likert 0 best to 10 worst), and patient satisfaction with pain management (Likert 6 very satisfied to 1 very dissatisfied) were evaluated.
Results: Data was obtained in 46 of 57 consecutive outpatient urethroplasties at a median 14 days after surgery. Median age was 52 years (range 18-77) and postoperative 72 hour pain score was 3 (range 0-8). A total of 7 (15%) patients reported narcotic use within 7 days before surgery. The median number of 5 mg oxycodone tablets used after urethroplasty was 3.5 (range 0-42); 36 of 46 (78%) men used 5 tablets or less. Excess narcotic was prescribed to 38 of 46 (83%) with a median 14 unused tablets (range 5-27) per patient. Postoperative narcotic usage did not differ by age, urethroplasty location, or use of buccal mucosa graft, but was significantly greater among patients that reported preoperative narcotic usage (median 15 vs. 3 tabs; p=0.0008). Men without preoperative narcotic usage rarely required > 5 tablets relative to those using narcotics preoperatively (13% vs. 71%; p=0.003). Overall, 93% (n=43) reported satisfaction (Likert score 5 or 6) with the postoperative pain management strategy.
Conclusions: In combination with the defined non-opioid care pathway, 5 tablets of 5 mg oxycodone provides satisfactory pain control following anterior urethroplasty in patients without preoperative opioid use, while limiting overprescribing.