The American Urological Association recently held its national meeting in Chicago and I had the privilege of attending.
While there were countless fascinating and thought provoking presentations and abstracts, this one was my favorite. It shows a novel method to minimize narcotic use following ureteroscopy.
Enhanced Recovery After Surgery Protocol for Ureteroscopy: A Prospective Comparative Study Evaluating A No Opioid vs Standard Protocol.
Presentation Authors: Chad Gridley*, Jennifer Robles, Joshua Calvert, Nicholas Kavoussi, Taylor Winkler, Jennifer Jayaram, Matthew Fosnot, Justin Liberman, Brian Allen, Matthew McEvoy, Duke Herrell, Ryan Hsi, Nicole Miller, Nashville, TN
Introduction: Nephrolithiasis patients undergoing ureteroscopy are at risk for opioid dependence due to the nature of the disease, multiple provider encounters across an acute episode, and surgical and stent-related pain. The objective of this study was to evaluate an Enhanced Recovery After Surgery (ERAS) care pathway that provides standardization for the anesthetic care and post-operative management of patients undergoing ureteroscopy and stent placement with a goal towards minimizing opioid exposure.
Methods: Consecutive patients undergoing ureteroscopy and stent placement were identified leading up to and after implementation of the ERAS protocol. Urinary symptoms, pain, and PROMIS survey scores were obtained before surgery. The ERAS protocol included preoperative non-opioid premedication, minimal intraoperative and post-anesthesia opioids, and explicitly written non-opioid discharge medications. Patients were contacted at 48-72 hours and seven days postop to obtain follow up survey scores. Unanticipated phone calls, emergency room visits, and need for opioid refills were obtained. Collected data was compared between the two study populations.
Results: Among 53 patients enrolled (29 pre-intervention, 24 ERAS), mean age was 54.2 years and 57% were women. There was no difference in gender or age between the groups. On univariate and multivariable analyses, there were no significant differences between preoperative and postoperative survey results (Figure 1). The difference in morphine equivalent dosages was significant (p < 0.001). There were no significant differences seen between pre- or post-ERAS groups for additional opioid requests, unexpected patient phone calls, or emergency room visits.
Conclusions: Implementation of this ERAS protocol for patients undergoing ureteroscopy and ureteral stenting resulted in reduction to almost near-zero levels of opioid prescribing with fewer post-operative phone calls and no adverse effect on patient reported outcomes, emergency room visits, or opioid refills.