Presentation Authors: Seth Teplitsky*, Philadelphia, PA, Patrick Pfizenmayer, Ronak Gor, Camden, NJ, Paul Chung, Philadelphia, PA
Introduction: Prescription opioids are a mainstay of postoperative pain management. We outlined the course and severity of postoperative pain in patients undergoing urethroplasty and inflatable penile prosthesis (IPP) in order to improve patient counseling and medication stewardship moving forward.
Methods: This IRB approved, prospective study was completed between 2017 to 2018 across two institutions. All patients who underwent urethroplasty or IPP placement were invited to participate. Patients did not receive any preprocedural pain management. Patients with chronic pain or active narcotic usage were excluded. The study consisted of completing a patient-reported questionnaire which monitored end of day pain on a 1-10 visual analog scale (VAS), pain medication usage (acetaminophen, ibuprofen, and oxycodone 5 mg), and bladder spasms until initial post-operative visit 2-3 weeks after surgery. VAS was categorized into severe (10-7), moderate (6-4) and mild (3-1). Post-operative pain was similar between the two operations and was therefore evaluated together.
Results: Fifteen patients (9 urethroplasty, 6 IPP) appropriately completed and returned the questionnaire. 13 patients (87%) reported mild or undetectable pain at follow up, while 2 patients had persistent pain. These groups were evaluated separately. Of the 13 patients who reported mild or resolved pain, they were only in severe pain for mean 1.4 days, with only 3 (23%) reporting any days in severe pain. Patients had their pain reduced to a mild level by a mean of 5.9 postoperative days. 9/13 (69%) patients used narcotics for a mean 3.9 days. Only 5 (38%) patients used narcotics for more than 1 day, 13 (87%) patients had leftover medication, and only 1 patient required a refill for narcotics. Patients used acetaminophen for a mean of 10.1 days and ibuprofen for 6.3 days. Only 1/9 urethroplasty patients in this group had bladder spasms. In the 2 patients whose pain persisted, they spent an average of 4.5 days in severe pain, 10.5 days in moderate pain, and 3 days in mild pain. They took narcotics, acetaminophen, and ibuprofen for a mean of 12.5, 13, and 9 days, respectively. Despite having extended pain, neither of these patients required a refill or used all prescribed narcotic.
Conclusions: Most patients reported an improvement to mild pain by 6 days and used narcotics for less than 4 days after urethroplasty and IPP. The results from this study have improved our pre-operative patient counseling and helped to decrease the strength and quantity of pain medication prescribed after surgery, thereby limiting exposure to potentially dangerous narcotics.