Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study

Abstract

OBJECTIVE To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. METHODS A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intra-operatively, in the recovery unit, and at home was recorded. RESULTS Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and “high-pain” measure (P = .02) CONCLUSION B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits.

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

“…23 Intraoperative use of nonopiate medications, such as intravenous toradol and belladonna opium suppositories have been shown to help with postoperative pain control after ureteroscopy. 11,24 Notably in this study, no surgical factors were identified as risk factors for persistent opiate use, including stent duration or sheath use. After surgery, providing a standardized MED per postoperative opiate prescription may help minimize the quantity of opiates prescribed and/or unused by patients.…”

“…7,8,10 Specifically, unanticipated visits after ureteroscopy for stone disease has been reported to be 6.6%, and the majority of these visits are made due to pain. 5,11 An important finding of our study is that most patients before stone surgery have had opiate exposure within the previous 30 days, and a significant proportion have had multiple prescriptions. This highlights a fundamental challenge of addressing how and when opiates are prescribed to kidney stone patients as they often encounter multiple providers across different settings.…”

Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis

“…24,25 Other medical therapies include anticholinergic medication with solifenacin, preoperative belladonna and opium suppository, and periureteral botulinum toxin type A injection. [26][27][28] Incorporation of certain medical therapies to reduce stent discomfort should be considered part of routine postoperative care after URS. While we found a significant association between phone calls with stent extraction string and stent removal at home, others have reported no difference in stent-related quality of life, pain at stent removal, rates of UTI, ED visits, or phone calls.…”

Effect of highly concentrated hyaluronic acid/chondroitin sulphate instillation on ureteric stent‐induced discomfort after ureteroscopic lithotripsy: a multicentre randomised controlled pilot study

“…They found that the bladder mucosa normalised after the instillation. Table 4 provides a summary of existing studies about this issue, and most of the studies used the USSQ to measure the clinical discomfort caused by ureteric stenting [31][32][33][34][35][36][37][38][39][40][41]. As shown in Table 3, current existing evidence supports the specific treatment strategy to control discomfort due to ureteric stent indwelling either by a-blockers or other treatments.…”