Presentation Authors: Ryan Donahue*, Basil Ferenczi, Kathryn Dahl, Daniel Warren, Neil Hanson, Christopher Porter, Paul Kozlowski, John Corman, Seattle, WA
Introduction: With the recognition that limiting opiate exposure mitigates long term dependency, efforts have been taken to critically assess perioperative narcotic use. Eight years ago we completed a prospective, randomized study that demonstrated improved post-operative pain control in patients who received a belladonna and opium suppository (BNO) upon anesthesia induction prior to robotic-assisted laparoscopic prostatectomy (Lukasewycz et al. Can J Urol 2010; 17:5377-82). Contemporarily, there are significant efforts to limit perioperative opiates, due to concerns that even limited use may contribute to long-term abuse. In the present study, we recontact our initial study participants to assess whether the perioperative exposure to opiates was associated with significant long-term narcotic use.
Methods: After Institutional Review Board approval, up to 3 attempts were made to contact each of the 99 patients from the initial study. After consent, a research nurse independent of the original study asked patients to complete a phone survey regarding current pain levels, analgesic use and any other prostate cancer treatments. The International Index of Erectile Function (IIEFF) and the American Urological Association Symptom Score (AUASS) were also administered.
Results: 59/99 original patients (59.6%) were reached and agreed to participate. Of these, 45 (76.3%) reported no current pain and 14 (23.7%) reported current musculoskeletal pain unrelated to their prostatectomy (Fig. 1). Of the patients who experience daily pain, 12/14 (85.7%) managed their discomfort without opiates; 2 reported current opiate use (oxycodone and tramadol). 1 of these patients was originally randomized to the BNO cohort while the other was in the non-BNO group. There were no statistical differences in IIEF, current protective pad usage or AUASS comparing patients reporting pain with patients reporting no pain.
Conclusions: In this 8-year post-operative follow-up study, 2/59 (3.4%) of patients report narcotic use for chronic pain not associated with their prostatectomy. This suggests that while perioperative narcotics may be used judiciously, a multimodal approach should be considered. Within our population, short-term narcotic exposure did not induce long-term dependency.