(348) Implementation of Opioid- Free and Opioid-Reduced Protocols for Postoperative Pain Management After Penile Prosthesis Surgery

Abstract

Abstract Introduction Postoperative pain management after (PP) penile prosthesis is challenging and it has traditionally required opioid medication. In light of the ongoing nationwide opiate epidemic and in an effort to reduce the risk of postoperative opioid dependence, urologic prosthetic surgeons have sought to establish opioid-free and/or opioid-reduced protocols (OFP, ORP respectively) for PP postoperative pain management. Objective This study seeks to investigate the patterns of adoption of OFP or ORP among surgeons who perform PP surgery and potential barriers to their implementation. Methods A 13-question confidential survey was sent to members of the Sexual Medicine Society of North America (SMSNA) via email. The survey was administered via Qualtrics. T-test was used to analyze survey responses. Results 43 urologists responded to the survey, with representation from every American Urologic Association geographic section. Most respondents (73.18%) performed penoscrotal PP and 43% of respondents performed more than 30 PP per year. OFP was used most of the time by 24.39% of respondents and ORP was used most of the time by 73.18%. No significant relationship was found between the use of an OFP/ORP and geographical region, number of implants performed per year, surgical approach, or location of reservoir placement. Of the respondents using an ORP, 100% prescribed 10 doses of opioid medication or less upon discharge. 41.51% of respondents used an OFP/ORP from published literature and 9.43% consulted their local anesthesia or pain management department. The most commonly used modalities of non-opioid analgesia were: non-steroidal anti-inflammatories (95.1%), acetaminophen (87.8%), dorsal penile block (80.4%), gabapentin (46.3%), and pudendal block (43.9%). Following initiation of an ORP/OFP, 9.3% reported an increase in phone calls and 11.6% reported an increase in refill requests. There were no reports of increased patient dissatisfaction. Most respondents (65.8%) were extremely satisfied with their protocols. Conclusions OFP/ORP after PP surgery appear to be widely adopted by the urologic prosthetic community without a significant increase in patient or surgeon dissatisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast (ASB).