Presentation Authors: Kirtishri Mishra*, Melody Chen, Laura Bukavina, Amr Mahran, Jonathan Kiechle, Michael Wang, Christina Buzzy, Lee Ponsky, Cleveland, OH, Christopher Gonzalez, Maywood, IL
Introduction: In 2015 there were more deaths related to opioid overdose (30,000) than renal cell carcinoma deaths (14,080). Furthermore previous studies have shown that a large percentage of patients do not use or fill the prescription for their analgesics. In this study, we evaluated whether ketorolac was equally as effective at pain control as oxycodone after routine outpatient urologic procedures. Secondarily, we evaluated whether patients disposed the leftover medications appropriately. We hypothesize that toradol is non-inferior to oxycodone, and that majority of patients do not dispose of their medications appropriately.
Methods: Patients undergoing routine outpatient urologic procedures with a GFR >40 ml/min/1.73 m2, were consented to participate in the study. Patients were randomized into the oxycodone (5mg tablet, 1-2 tablets every 4 hours for 5 days) or the ketorolac (10mg tablet, 1 tablet every 6 hours for to 5 days) arm. Patient demographics, Charlson Comorbidity score, operative procedure details, and complications were recorded. A phone survey was conducted one week after surgery to determine level of pain control, number of pills taken, and method of pill disposal. A validated pain scale (Indiana Polyclinic Combined Pain Scale) was used to elicit patient responses about their post-operative pain.
Results: A total of ninety-one patients were recruited. Table 1 shows that overall there was no difference in demographics between the two groups. The oxycodone group used significantly more pills compared to ketorolac (7.4 vs 3.1; p = 0.005). In addition, the oxycodone group was significantly more likely to hold onto their pills or dispose them inappropriately despite being provided written and oral instruction on appropriate disposal methods. There was no difference in pain levels.
Conclusions: Toradol is a non-inferior alternative to oxycodone for outpatient urologic procedures in properly selected patients. A large percentage of patients in both groups did not fill or use their analgesics. Only 9% of patients disposed of their medications appropriately. Patient and physician education is necessary to curtail the indiscriminate prescription, use, and disposal of opioids.