Initial Experience with Narcotic-Free Ureteroscopy: A Feasibility Analysis

Large, Tim; Heiman, Joshua; Ross, A. H. McL.; Anderson, Blake; Krambeck, Amy E.

doi:10.1089/end.2018.0459

Cited by 36 publications

(23 citation statements)

References 12 publications

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“…Recent studies have demonstrated success in opioid‐free postoperative pain control. A retrospective review of patients undergoing cystoscopy found that prescribing patients diclofenac instead of hydrocodone or oxycodone resulted in nearly identical number of calls for postoperative pain issues . Non‐narcotic management of postoperative pain following pediatric robotic pyeloplasty showed shorter length of stay without increase in complications .…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Objective To compare postoperative pain control among men who received different quantities of narcotic prescriptions following scrotal surgery. We hypothesized that men receiving eight vs four pills of acetaminophen 300 mg/codeine 30 mg there would be no significant difference in mean pain following scrotal and inguinal surgery. Patients and methods In this prospective, open‐label study, men who underwent scrotal surgery received eight or four acetaminophen 300 mg/codeine 30 mg pills. Men were encouraged to take scheduled non‐steroidal anti‐inflammatory drugs (NSAIDs), apply ice on the incision, and take acetaminophen 300 mg/codeine 30 mg as needed for breakthrough pain. Men were evaluated within 1‐2 weeks after surgery. Statistical analysis was performed using Microsoft Excel and Stata/IC 15.1. Results A total of eighty‐seven men met inclusion criteria, fifty‐four men received eight acetaminophen/codeine pills, and thirty‐three men received four pills. There was no significant difference in mean pain score (0‐10) of men receiving eight pills vs four pills in the week after surgery (3.6 ± 1.9 vs 3.3 ± 1.8, P = .5004). Of men who used NSAIDs and ice, 93.5% and 92.3% found them to be moderately or very helpful. Conclusion Reducing the total prescription of combined narcotic/non‐narcotic medication is not associated with increased postoperative pain in patients undergoing scrotal/inguinal surgery. There was no difference in postoperative pain in men taking eight or four acetaminophen 300 mg/codeine 30 mg pills. A limited prescription of eight or four pills was adequate for pain control in the majority of men who underwent scrotal surgery. NSAIDs and ice were found to be useful adjuncts for pain relief by those who used them.

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Section: Discussionmentioning

confidence: 99%

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

2020

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“…21,22 Opiate-free protocols after ureteroscopy have been shown to be feasible. 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.…”

Section: Discussionmentioning

confidence: 99%

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Kang

Shu

Herrell

et al. 2019

Journal of Endourology

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Objective: Kidney stone formers are at risk for opioid dependence. The aim of this study is to describe opiate exposure and determine predictors of prolonged opiate use among kidney stone formers after surgery. Materials and Methods: A retrospective review was performed among patients who underwent ureteroscopy for upper tract stone disease. Prescription data were ascertained from a statewide prescribing database. Demographic data and surgical factors were collected from the electronic medical record. Predictors of additional postsurgery prescriptions filled within 30 days and persistent opiate use 60 days after ureteroscopy were determined. Results: Among 208 patients, 127 (61%) had received preoperative opiate prescriptions within 30 days before surgery. Overall, 12% (n = 25) of patients required an additional opiate prescription within 30 days after ureteroscopy, and 7% (n = 14) of patients continued to use opiate medications more than 60 days postoperatively. Patients continuing to use opiates long-term were not chronic opiate users. For both outcomes, preoperative opiate exposure, including number of prescriptions, days prescribed, and unique providers had significant associations (all p < 0.05). Additionally, younger age (p = 0.049) was associated with obtaining an additional opiate prescription within 30 days. Lower BMI (p = 0.02) and higher ASA score (p = 0.03) were predictors of continued opiate use more than 60 days after ureteroscopy. Conclusions: The majority of stone formers have had opiate exposure before surgery, often from multiple providers. Approximately 1 in 8 stone formers who undergo ureteroscopy require additional opiate prescriptions within 30 days. A small but significant population receive opiates beyond the immediate postoperative period.

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“…1 F-URS is increasing in prevalence, 16 and with new frontiers in opioid-free surgery and cost containment. 17,18 A significant amount of resources are directed toward sterile processing, 19 maintaining, repairing and replacing flexible endoscopes. 20 In the last 5 years, numerous publications have evaluated the safety, quality, environmental impact and cost of disposable ureteroscopes.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience with Novel Single-Use Disposable Ureteroscopy: A Prospective, Single Arm 90-Day Trial of the Axis Ureteroscope

et al. 2021

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Introduction: Novel digital disposable ureteroscopes are becoming more commonplace in endourological practices. We trialed the AxisÔ single-use ureteroscope, which is distributed within the United States by Dornier MedTech. Our goal was to demonstrate clinical equivalence to our reusable platform and to evaluate the cost-effectiveness of a single-use digital ureteroscope.Methods: We conducted a prospective 90-day trial where all flexible ureteroscopic procedures were completed using the single-use ureteroscope. The cases were monitored for scope failure, scope deficiencies and surgeon satisfaction scores via an immediate postoperative REDCapÒ survey. We also performed a cost analysis between reusable scopes and the single-use ureteroscope. The cost of the reusable platform included the amortized initial purchase, maintenance and clean processing.Results: Over a 90-day period, we performed 93 flexible ureteroscopy procedures with a single-use ureteroscope, of which 74 were completed using Axis. After controlling for operating room time and disposable items used, the utilization of Axis was associated with an average reduction of $140.31 per case. Extrapolating the per-case savings over an annual case volume, we estimate a total savings of $56,127.15. There were no disposable scope malfunctions. There were 4 (4.3%) cases converted to reusable scopes due to image quality (1), inadequate secondary deflection (2) and a tight ureter (1). MeanAESD score for image quality, mobility and ergonomics was 9.1AE1.1, 8.9AE1.1, 9.3AE1.1, respectively. The 90-day complication rates were equal to our controls. Conclusions:We demonstrated that the Axis single-use digital ureteroscope is equivalent in function to our digital reusable scope and reduced the cost of flexible ureteroscopy.

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Initial Experience with Narcotic-Free Ureteroscopy: A Feasibility Analysis

Cited by 36 publications

References 12 publications

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

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

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Initial Experience with Novel Single-Use Disposable Ureteroscopy: A Prospective, Single Arm 90-Day Trial of the Axis Ureteroscope

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