Routine Prescription of Opioids for Post-Vasectomy Pain Control Associated with Persistent Use

Abstract

Purpose: The AUA (American Urological Association) Position Statement on opioid use recommends using opioids only when necessary. We sought to determine if routine prescribing of opioids is necessary for pain control after vasectomy, and if an association exists with persistent use. Materials and Methods: We retrospectively reviewed the charts of patients who underwent vasectomy in clinic between April 2017 and March 2018. Patients were stratified into 2 groups, including those initially prescribed opioids and those not receiving opioid prescriptions at the time of vasectomy. The initial pain medication regimen depended on the standard prescription practice of each provider. Encounters with a medical provider for scrotal pain within 30 days, subsequent opioid prescriptions and new persistent opioid prescriptions between 90 and 180 days were compared between the 2 groups using the Fisher exact test. Results: Between April 2017 and March 2018 a total of 228 patients underwent clinic vasectomy as performed by 8 urologists. At the time of vasectomy 102 patients received opioid prescriptions and 126 received no opioid prescriptions. There was no statistically significant difference between the opioid and nonopioid groups in encounters for scrotal pain (12.7% vs 18.4%, p [ 0.279). The incidence of new persistent opioid use was 7.8% in the opioid cohort compared to 1.5% in the nonopioid cohort (p [ 0.046). Conclusions: Opioids, which do not appear to be necessary in men who undergo vasectomy, were associated with persistent use in 7.8% of patients at 3 to 6 months. In the face of an opioid epidemic urologists should take action to limit over prescription of opioids after vasectomy.

National opioid prescription patterns and patient usage after routine vasectomy

“…Reassuringly, most urologists wrote for a small number of opioid tablets, with 66.7% prescribing 5–10 tablets. Barham et al found that most urologists prescribed a range of 5–20 opioid tablets for post‐vasectomy pain control (Barham et al, 2019); our data suggest that this is closer to the 5–10 range versus 10–20.…”

Opioid prescribing after urologic surgery: we are part of the problem and part of the solution—an invited commentary on “an opioid prescription for men undergoing minor urologic surgery is associated with an increased risk of new persistent opioid use”

“…is notably lower than previous reports detailing outcomes in urologic surgery populations, where it has been estimated that 6-9% of patients show evidence of persistent use at three-months after surgery (13,18,19). Using a similar dataset and rigorous methodology, Hosier and colleagues found a 9% rate of persistent opioid use at three-months postoperatively (after initial perioperative exposure) in a cohort of nearly 102,000 patients who underwent treatment for urolithiasis from 2013-2017 (20).…”

Vasectomy: a guidelines-based approach to male surgical contraception

“…More alarmingly, there are many patients who then have excess narcotics, which are unlikely to be disposed of properly and may be abused in the future by patients or their acquaintances (25). Barham and co-workers found that routine postvasectomy opioid prescriptions resulted in 7.8% of previously opioid-naïve patients having persistent opioid use 90 days after vasectomy (26). A better pain management strategy would be to emphasize nonsteroidal anti-inflammatory drugs.…”