Decreased Opioid Prescription With Low Pain Scores After Urethroplasty: Using a Simplified, Multimodal, Opioid Minimization Pain Protocol

Abstract

ObjectivesTo implement a simplified, opioid-minimized, multimodal pain management (MPM) protocol (Figure 1) and assess its effectiveness of reducing opioid dispersion while maintaining low postoperative complications, patient-reported pain, and patient-reported interference with quality of life (QOL) for men undergoing urethroplasty. Methods95 men at a single academic center from October 2020-October 2023 received a urethroplasty. We retrospectively reviewed the prior standard pain management (SPM) cohort before August 2021, then prospectively studied the MPM cohort after August 2021. For the SPM cohort, we collected postoperative day (POD) 1 pain scores from our EMR. For the MPM cohort, we obtained a validated pain and QOL assessment in the early postoperative period. The SPM cohort’s POD 1 pain scores were compared with the MPM cohort’s POD 2 pain scores. Opioid dispensation records were queried from the Prescription Monitoring Program. Results75 MME fewer opioids in the MPM cohort were prescribed than the SPM cohort (0 (interquartile range [IQR]: 0-0) vs. 75 (IQR:0-150), p<0.001, respectively). Patients with opioid discharge prescriptions fell from 50% in the SPM cohort to 11% in the MPM cohort (p<0.001). Early postoperative pain scores remained low and showed no significant difference between the cohorts. Pain’s interference with QOL measures remained low. Complications were rare across both cohorts. ConclusionThis simplified, multimodal analgesia protocol effectively decreases postoperative pain and opioid dispersion without affecting QOL outcomes after urethroplasty. This pain regimen can be easily adopted to decrease the use of postoperative opioids in men undergoing urethroplasty.