MP03-19 SUPPORT FOR MINIMIZING NARCOTIC REQUIREMENT FOLLOWING URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-19 SUPPORT FOR MINIMIZING NARCOTIC REQUIREMENT FOLLOWING URETHROPLASTY Chase Mallory, Alejandra Perez, Adam Nolte, Scott Jamieson, Jessica Boyer, Dhaval Jivanji, Spencer Liem, and Billy Cordon Chase MalloryChase Mallory More articles by this author , Alejandra PerezAlejandra Perez More articles by this author , Adam NolteAdam Nolte More articles by this author , Scott JamiesonScott Jamieson More articles by this author , Jessica BoyerJessica Boyer More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Spencer LiemSpencer Liem More articles by this author , and Billy CordonBilly Cordon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The opioid epidemic has led to increased use of non-narcotic post-surgical pain management. While many studies have assessed preoperative adjunct measures to decrease postoperative narcotic requirements, few studies have looked directly at optimal postoperative pain management following urethroplasty both in the peri- and postoperative settings and upon discharge. In this study, we aim to characterize pain control for patients undergoing urethroplasty and provide alternative non-narcotic adjuncts. METHODS: We retrospectively reviewed clinical and procedural characteristics for all patients that underwent urethroplasty at our institution from August 2016 through February 2021. The primary outcome was milligram morphine equivalents (MME) which is the amount of morphine (mg) equal to the strength of opioid prescribed. We utilized peripheral nerve blocks intraoperatively including a pudendal block along with a long buccal nerve block prior to buccal mucosa harvest, performed by infiltrating the buccal sulcus just distal to the last molar tooth. This strategy was implemented on December 2018 in efforts to decrease perioperative morbidity associated with buccal harvest. RESULTS: We identified 77 patients that underwent urethroplasty: 58% augmented and 26% anastomotic. 60% of patients did not receive any narcotics in the immediate postoperative period while 32.5% received 0.1-5 MME, and only 6.5% received >5 MME. When comparing groups before and after implementation of buccal nerve block, patients received 3.7 vs 1.18 MME (p=0.021) in the immediate postop period and 15.8 and 8.9 ME (p= 0.22) during admission. When breaking down by surgery type, we also noted a trend for patients who had augmented urethroplasty to have higher MME requirements. CONCLUSIONS: Non-narcotic alternatives following urethroplasty, such as NSAIDs and anticholinergics are viable options for pain control in certain patient cohorts. Our preliminary analysis demonstrates decreased need for post-operative narcotic pain control with intra-operative nerve blocks. Further studies will focus on identifying patient factors predictive of narcotic requirement to build an algorithmic approach that would minimize narcotic use and ultimately addiction. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e28-e28 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chase Mallory More articles by this author Alejandra Perez More articles by this author Adam Nolte More articles by this author Scott Jamieson More articles by this author Jessica Boyer More articles by this author Dhaval Jivanji More articles by this author Spencer Liem More articles by this author Billy Cordon More articles by this author Expand All Advertisement Loading ...