التفاصيل البيبلوغرافية
| العنوان: |
Opioid-free percutaneous nephrolithotomy: an initial experience. |
| المؤلفون: |
Khargi, Raymond, Yaghoubian, Alan J., Blake, Ryan M., Ricapito, Anna, Connors, Christopher, Gallante, Blair, Khusid, Johnathan A., Atallah, William, Gupta, Mantu |
| المصدر: |
World Journal of Urology; Nov2023, Vol. 41 Issue 11, p3113-3119, 7p |
| مصطلحات موضوعية: |
PERCUTANEOUS nephrolithotomy, INAPPROPRIATE prescribing (Medicine), POSTOPERATIVE pain treatment, FISHER exact test, MANN Whitney U Test, OPIOID epidemic |
| مصطلحات جغرافية: |
UNITED States |
| مستخلص: |
Introduction: The opioid epidemic in the United States is an ongoing public health crisis that is in part fueled by excessive prescribing by physicians. Percutaneous nephrolithotomy (PCNL) is a procedure that conventionally involves opioid prescriptions for adequate post-operative pain control. We aimed to evaluate the feasibility of a non-opioid pain regimen by evaluating post-operative outcomes in PCNL patients discharged without opioids. Materials and methods: As a quality improvement measure to reduce opioid consumption our department began routinely prescribing oral ketorolac instead of oxycodone–acetaminophen for pain control after PCNL. We retrospectively compared patients undergoing PCNL who had received ketorolac prescriptions (NSAID) to those who received oxycodone–acetaminophen prescriptions (NARC). Demographic, operative, and post-operative factors were obtained and compared in both groups. Peri-operative factors and demographics were compared using either Chi-squared tests, Mann–Whitney U tests. Surgical outcomes were compared between the two groups using Chi-squared tests and Fisher's exact tests. Multivariate logistic regression analysis was performed to determine whether ketorolac use was an independent predictor of post-surgical pain-related encounters. Primary outcome was unplanned pain-related healthcare encounters inclusive of office phone calls, unscheduled office visits, and emergency department (ED) visits. Secondary outcome measures were non-pain-related healthcare encounters, hospital readmissions, pain-related rescue medications prescribed, and post-op complications. Results: There were similar demographics and peri-operative characteristics amongst patients in both cohorts. There was no significant difference identified between NSAID and NARC regarding unplanned pain-related encounters (8/70, 11.4% vs. 10/70, 14.3%, p = 0.614). However, NARC experienced more unplanned phone calls (42, 60% vs. 24, 34.3%, p = 0.004). Multivariate analysis revealed only prior stone surgery was predictive of pain-related encounters after PCNL (p = 0.035). Conclusion: Our results show that there were no significant differences in pain-related encounters between those who received ketorolac and oxycodone–acetaminophen following PCNL. A non-opioid pathway may mitigate the potential risk associated with opioid prescription without compromising analgesia. Prospective comparative studies are warranted to confirm feasibility. [ABSTRACT FROM AUTHOR] |
|
Copyright of World Journal of Urology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
