Decreasing postoperative opioid use while managing pain: A prospective study of men who underwent scrotal surgery

Ramos, Libert; Dubin, Justin M.; Ramasamy, Ranjith

doi:10.1002/bco2.12

Cited by 7 publications

(6 citation statements)

References 13 publications

(15 reference statements)

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“…Even for minor scrotal surgery, Greer et al noted that when men were prescribed 8 tablets of codeine, they used twice as many doses compared to the patients who received only 4 tablets, and still maintaining adequate pain control. 17 These findings are consistent with other reports suggesting that it is the dose and the availability of prescribed opioids, and not necessarily the pain or the procedure, that drive consumption of prescription opioids.…”

Section: Discussionsupporting

confidence: 91%

“…Nineteen studies (8,407 patients; 4,443 in the pre- and 4,031 in the post-intervention cohort) reported sufficient data on prescribed opioids in both cohorts to allow for pooled analysis. 10–25,28,30–32 A significant reduction in prescribed opioids at discharge was noted in all except 1 study following the implementation of various interventions. The mean overall reduction in the post-intervention cohort was −67.59 MME (95% CI 54.23–80.94, p <0.001, I 2 =95%; fig.…”

Section: Resultsmentioning

confidence: 91%

“…Of the 8,904 patients from 22 studies used for the qualitative review, 4,560 patients were in the pre-intervention cohort and 4,251 patients in the post-intervention cohort. 10–32 Direct interventions to reduce opioid prescriptions were evaluated in 16 studies 11,12,14,15,18–21,25–29,31 (7,086 patients), while 6 studies 10,13,16,24,30,32 (1,818 patients) evaluated the effects of various indirect interventions. In 12 studies, 10,11,14,16,19,21,24–26,29,30,32 the procedures were categorized as major surgery, while 7 studies 12,13,18,20,22,23,27 included minor procedure and 3 studies 16,28,31 included both.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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Purpose: Opioid prescriptions after surgery are major contributors to the opioid abuse epidemic. Several measures designed to limit opioid prescriptions at discharge have been evaluated. We conducted a comprehensive review and metaanalysis of the effectiveness of various types of interventions in reducing opioid prescriptions after urological surgery. Materials and Methods: A systematic review including MEDLINEÒ, Web of ScienceÔ and Cochrane databases was conducted to identify studies on opioid prescriptions and urological surgery. Twenty-two studies met the inclusion criteria, of which 19 were used for quantitative analysis for reduction in opioid prescriptions. Additional outcomes included opioid consumption and satisfaction with analgesia. Results: Of the 8,318 patients, 53% were in the pre-and 47% in the postintervention cohort. Overall mean reduction/patient in prescribed opioids was À67.59 (95% CI 54.23 to 80.94) morphine milligram equivalents (MME). Direct interventions, implemented by providers within their local department or hospital, were more effective in reducing prescribed opioids compared to indirect, or systemic, interventions, at À76.68 MME (95% CI 60.04 to À93.31) vs À46.72 MME (95% CI 24.20 to À69.23; p[0.04). Opioid consumption significantly decreased post-intervention with a mean reduction of -18.31 MME (95% CI 7.89 to 28.72). Patient satisfaction with analgesia remained unchanged between the pre-and post-intervention groups. Conclusions: Successful reduction in opioid prescriptions, without compromising pain control, can be achieved through a variety of interventions. Direct interventions appear to have a greater impact than indirect interventions in reducing opioid prescriptions. Despite the reduction, unused, excess prescription opioids were still noted, which provides an opportunity for further control on opioid prescriptions.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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“…One prospective study compared postoperative pain control among men receiving different quantities of narcotic prescriptions after scrotal surgery. 59 In this study, reducing total prescription for narcotic/non-narcotic medication was not associated with increased postoperative pain; limited prescription alongside non-steroidal anti-inflammatory drugs and ice were adequate for pain control. 59 In another study, celecoxib started twice daily preoperatively netted a significant decrease in postoperative pain and opioid use for patients who underwent microsurgical testicular sperm extraction procedures.…”

Section: Opioids In Scrotal and Testicular Surgerymentioning

confidence: 58%

Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?

Anderson

Cao

Zhou

et al. 2022

Health Psychology Research

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Urologic procedures (both open and minimally invasive) can cause pain due to the surgery itself, devices placed, and post-operative issues. Thus, pain management is important for every post-procedure recovery period. Opioid use post-surgery is common and often over-prescribed contributing to persistent use by patients. In this article, we review the extent of opioid use in pediatric urologic procedures, vasectomy, endourologic procedures, penile implantation, urogynecologic procedures, prostatectomy, nephrectomy, cystectomy, and scrotal/testicular cancer surgery. Generally, we have found that institutions do not have a standardized protocol with a set regimen to prescribe opioids, resulting in more opioids being prescribed than needed and patients not properly disposing of their unused prescriptions. However, many institutions recognize their opioid overuse and are implementing new multimodal opioid-sparing analgesics methods such as non-opioid peri-operative medications, minimally invasive robotic surgery, and nerve blocks or local anesthetics with varying degrees of success. By shedding light on these opioid-free methods and prescription protocols, along with improved patient education and counselling, we hope to bring awareness to institutions and decrease unnecessary opioid use.

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“…A recent prospective evaluation of patients undergoing ureteroscopy found that patients can successfully be discharged without an opioid prescription (8). With respect to scrotal surgery, a prospective study found no difference between pain scores post scrotal surgery in men receiving 8 versus 4 narcotic pills (9). But what if we could limit it to 0 pills post scrotal surgery?…”

mentioning

confidence: 99%

Evaluating the opioid epidemic: a urologist’s promise to curb the crisis

Pathak¹,

Hemal²

2021

Transl Androl Urol

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Acute overdose due to opioid ingestion is a leading cause of emergency room visits in North America. Contrary to popular belief, most opioid abuse derives from prescription medication rather than illicit drug use (1). The exact etiology of opioid abuse stems from not taking the medication as prescribed or by using opioids that were allotted to another patient. The misuse of opioids has spawned the CDC to label it the "fastest growing drug problem in the United States". In fact, overdose secondary to opiate medication has dramatically increased since 1999, with 6-fold increase in the number of deaths occurring in 2017 (2). Therefore, adaptation by the physician, as the gatekeeper of prescriptions, represents an integral component to circumvent this growing epidemic.Welk et al. indirectly defined the addictive nature of opioid medication in their manuscript entitled "An opioid prescription for men undergoing minor urologic surgery is associated with an increased risk of new persistent opioid use" (3). Utilizing a variety of population-level databases centralized to Ontario, Canada, the authors examined the implicit nature of opioid dependence after urologic surgery. Using minor procedures, such as transurethral prostatectomy, internal urethrotomy, and scrotal surgery as a reference, the authors measured the receipt of a second opioid prescription filled 9 to 15 months postoperatively. Key to the findings of the manuscript is that men who filled the initial opioid prescription were significantly more likely to fill a second opioid prescription and more likely to require an emergency visit or hospital admission for opioid intoxication (3). In fact, "for every 148 men who received a post-procedure opioid

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Decreasing postoperative opioid use while managing pain: A prospective study of men who underwent scrotal surgery

Cited by 7 publications

References 13 publications

Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?

Evaluating the opioid epidemic: a urologist’s promise to curb the crisis

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