AUA 2017: Effect of Different Postoperative Pain Medications on Return for Unplanned Care after Ureteroscopy

Boston, MA (UroToday.com) After ureteroscopy, patients experience discomfort that manifests as flank or bladder pain. To treat for this, most patients are prescribed centrally acting opioid medication. In America, effort is being made to reduce narcotic abuse as its use is association with unpleasant and dangerous effects. This study investigates the impact of different strengths of postoperative opioid medications on the rate of patient return to the emergency room (ER), unplanned clinic visit for pain, or overall 3-month readmission rate.

This study retrospectively reviewed charts for patients who underwent outpatient ureteroscopy for purposes of renal or ureteral stone removal from February 1, 2014 through March 31, 2016. Prescribed pain medication and the patients postoperative course was evaluated for the first 3 months after surgery. Both ER visits, and clinic calls/visits were analyzed. Those patients who reported to the ER for reasons not pertaining to urinary or flank pain, were excluded. Pain medications were classified into 4 categories based on their DEA drug schedule: Schedule 2, 3, 4, and over the counter (OTC) medications. A Chi-square test was used for analysis.

The study included a total of 475 patients who were identified with complete charts and follow up. 199 patients received schedule 2 medications, 165 received schedule 3 medications, 72 received schedule 4 medications, and 39 received OTC medications. The rates of return to ER, clinic, or readmission within 3 months were not significantly different from each other (p=0.25, p=0.21 p=0.31, respectively).

The study concluded that the type of pain medication prescribed after ureteroscopy has no bearing on whether a patient will present to their urologist with continuous postoperative pain. Medications that have a higher abuse potential, like hydrocodone and oxycodone, do not have the preventive ability to overcome out of control pain in the postoperative period more than safer alternatives. Postoperative pain medication did not impact re-admission rate within 3 months. A future direction is to reconsider narcotic prescriptions after ureteroscopy with the intentions to reduce overdose and abuse.

Presented by: Preston Milburn

Authors: Preston Milburn*, Graham Machen, Amr Elmekresh, Kristofer Wagner, Erin Bird, Marawan El Tayeb, Temple, TX

Affiliation: Endoourology & Stone Unit, The Institute of Urology, University of London Hospitals NHS Trust, London UK

Written By: Kheira Bettir from the University of California, Irvine for UroToday.com

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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