There is an opioid crisis in America; of that no one disagrees. The reasons for the crisis on the other hand are hotly debated.
I was speaking at the Rocky Mountain Urological Society’s annual meeting recently and the lecturer who followed me was Dr. Nicole Miller of Vanderbilt University. Dr. Miller is an incredible lecturer and one of America’s foremost kidney stone experts. She gave a talk about post ureteroscopy pain control that changed my practice.
Surgery hurts; and surgeons are not sadists. As a result, I was trained to prescribe narcotics in the immediate post-operative period. Dr. Miller presented unequivocal data that narcotics do not help control post-ureteroscopy pain.
Think about that for a moment. What a generation of doctors has been doing in an honest effort to help their patients has been wrong.
It turns out that in the post-ureteroscopy setting, a combination of Tylenol, ibuprofen, Tamsulosin and oxybutynin is all that it takes.
Further it turns out that 1/10 patients who are given narcotics for post-operative pain become addicted to the medications. As a result, I intend to immediately change my practice to dramatically limit the narcotics that I prescribe in the post-ureteroscopy setting and will highly encourage all of my colleagues to do the same.