Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;41(11):3113-3119.
doi: 10.1007/s00345-023-04600-y. Epub 2023 Sep 21.

Opioid-free percutaneous nephrolithotomy: an initial experience

Raymond Khargi  1 , Alan J Yaghoubian  2 , Ryan M Blake  2 , Anna Ricapito  3 , Christopher Connors  2 , Blair Gallante  2 , Johnathan A Khusid  2 , William Atallah  2 , Mantu Gupta  2
Affiliations

Opioid-free percutaneous nephrolithotomy: an initial experience

Raymond Khargi et al. World J Urol. 2023 Nov.

Abstract

Introduction: The opioid epidemic in the United States is an ongoing public health crisis that is in part fueled by excessive prescribing by physicians. Percutaneous nephrolithotomy (PCNL) is a procedure that conventionally involves opioid prescriptions for adequate post-operative pain control. We aimed to evaluate the feasibility of a non-opioid pain regimen by evaluating post-operative outcomes in PCNL patients discharged without opioids.

Materials and methods: As a quality improvement measure to reduce opioid consumption our department began routinely prescribing oral ketorolac instead of oxycodone-acetaminophen for pain control after PCNL. We retrospectively compared patients undergoing PCNL who had received ketorolac prescriptions (NSAID) to those who received oxycodone-acetaminophen prescriptions (NARC). Demographic, operative, and post-operative factors were obtained and compared in both groups. Peri-operative factors and demographics were compared using either Chi-squared tests, Mann-Whitney U tests. Surgical outcomes were compared between the two groups using Chi-squared tests and Fisher's exact tests. Multivariate logistic regression analysis was performed to determine whether ketorolac use was an independent predictor of post-surgical pain-related encounters. Primary outcome was unplanned pain-related healthcare encounters inclusive of office phone calls, unscheduled office visits, and emergency department (ED) visits. Secondary outcome measures were non-pain-related healthcare encounters, hospital readmissions, pain-related rescue medications prescribed, and post-op complications.

Results: There were similar demographics and peri-operative characteristics amongst patients in both cohorts. There was no significant difference identified between NSAID and NARC regarding unplanned pain-related encounters (8/70, 11.4% vs. 10/70, 14.3%, p = 0.614). However, NARC experienced more unplanned phone calls (42, 60% vs. 24, 34.3%, p = 0.004). Multivariate analysis revealed only prior stone surgery was predictive of pain-related encounters after PCNL (p = 0.035).

Conclusion: Our results show that there were no significant differences in pain-related encounters between those who received ketorolac and oxycodone-acetaminophen following PCNL. A non-opioid pathway may mitigate the potential risk associated with opioid prescription without compromising analgesia. Prospective comparative studies are warranted to confirm feasibility.

Keywords: Kidney stone disease; NSAIDs; Opioids; PCNL; Pain control.

PubMed Disclaimer

References

    1. Leapman MS, DeRycke E, Skanderson M et al (2018) Variation in national opioid prescribing patterns following surgery for kidney stones. Pain Med 19(suppl_1):S12–S18. https://doi.org/10.1093/pm/pny125 - DOI - PubMed
    1. Serna J, Talwar R, Lee DJ (2020) Reducing opioid use after endourologic procedures. Curr Urol Rep 21(5):20. https://doi.org/10.1007/s11934-020-00975-2 - DOI - PubMed
    1. Kalso E, Edwards JE, Moore AR, McQuay HJ (2004) Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112(3):372–380. https://doi.org/10.1016/j.pain.2004.09.019 - DOI - PubMed
    1. Rudd RA, Seth P, David F, Scholl L (2016) Increases in drug and opioid-involved overdose deaths United States, 2010–2015. MMWR Morb Mortal Wkly Rep 65(50–51):1445–1452. https://doi.org/10.15585/mmwr.mm655051e1 - DOI - PubMed
    1. Bamberger JN, Gallante B, Khusid JA et al (2022) A prospective randomized study evaluating the necessity of narcotics following ureteroscopy for urinary stone disease. World J Urol 40(10):2567–2573. https://doi.org/10.1007/s00345-022-04099-9 - DOI - PubMed

MeSH terms

LinkOut - more resources