Presentation Authors: Christian Tabib*, Kevin Cwach, Michael Schwartz, New Hyde Park, NY
Introduction: Narcotic abuse has continued to climb with studies showing those who abuse narcotics have obtained them through family members or friends. These direct connections are most likely to have received them directly from health care prescribers. A number of studies have looked at practice patterns within the field of urologic surgery. However, there are no studies that have quantified the effectiveness of analgesics in the immediate post-operative period.
Methods: Patients undergoing ureteroscopy (URS) or transurethral resection of bladder tumor (TURBT) ambulatory cases were given discharge instructions to record details regarding their post-operative pain including: rating on a pain scale (1-10), day of pain, analgesic used, and post-medication pain scale. Patients were then called on post-operative day three and their results were discussed. Pre- and post- medication pain scores were evaluated and associated with mild (0-2 points of relief), moderate (3-4 points), or substantial (5 and greater points) improvements in pain. Statistical analysis was done using Fischerâ€™s exact and chi square testing.
Results: Between July and September 2018, 70 patients were called in their immediate post-operative course. Of these patients, 36 who underwent either URS (22) or TURBT (14) were called and were willing to discuss their recorded findings. Of these patients, 21/36 (58%) admitted to any level of pain requiring medication. The majority of these patients were from URS as compared to TURBT (17 vs 4, p=0.006). Of those given narcotics who had pain, 10/16 (62.5%) elected to initially take a narcotic no matter the pain score (Median 8 +/- 2.5, Range 3-10). When comparing pain score improvements (mild, moderate, substantial) between NSAIDs and narcotics (2 vs 15, 6 vs 4, 6 vs 5, p=0.015), a significant difference was found favoring NSAIDs for moderate to substantial relief. No patients reported taking narcotics after post-operative day 2.
Conclusions: This study describes the post-operative pain experienced after ambulatory upper and lower tract endoscopic procedures. While narcotics appear to be an effective analgesic for all types of pain, this study shows that it is no better if not less effective than NSAIDs for substantial pain relief. Given the current epidemic of opioid and prescription narcotic abuse, it is important to minimize narcotic prescriptions. This study shows that narcotics can be prescribed at a minimum level but also proves the benefits of other analgesics such as ketorolac for ambulatory endoscopic procedures of both upper and lower tracts.