126 The Role of a Multimodal Analgesic Protocol in Decreasing Use of Narcotics

Abstract

The penile implant is an effective strategy for managing medication refractory erectile dysfunction. Despite the high patient and partner satisfaction rates1, post-operative pain can be significant. In an effort to manage pain, clinicians often resort to the use of opioid prescriptions However, the American opioid crisis has led physicians to seek alternative strategies for managing patient’s post-operative pain. A multimodal analgesic protocol consisting of acetaminophen, gabapentin, meloxicam, and local anesthetics, has been described in an effort to decrease narcotic usage while maintaining satisfactory pain control.2 The purpose of this study was to assess the efficacy of a multimodal analgesic protocol in decreasing narcotic usage following penile prosthesis This is a single-institution, single surgeon, retrospective review 55 primary three-piece penile prosthesis cases performed between September 2018 and November 18, 2018. All cases were placed through an infrapubic approach and performed on an outpatient basis. Prior to November 1st, 2018 patients were given an intraoperative dose of ketorolac if their renal function allowed and were subsequently discharged home with a prescription for Lortab and tramadol (20 pills each). Following November 1st, 2018 patient’s pain was managed according to a multimodal protocol as a described by Simhan et. al. Patients were given pre-operative acetaminophen, gabapentin, and meloxicam in the holding area 1 hour prior to surgery. An intraoperative local anesthetic pudendal nerve block was performed with 30 ml of bupivacaine and patients were discharged home with a prescription for Lortab (20 pills), gabapentin, and meloxicam. The main outcome measure was the number of post-operative phone calls for narcotic refills during the 30-day post-op period.