MP44-08 OPIOID-FREE ANALGESIA FOLLOWING VASECTOMY REVERSAL

Abstract

INTRODUCTION AND OBJECTIVE: North America is currently dealing with a wide-spread and highly publicized opioid “crisis”. Over use of opioid medications, combined with concerns related to drug purity and contamination have resulted in narcotic addition, overdose and death. According to the CDC, 130 deaths daily are attributed to opioid overdose in North America. Consequently, many surgeons have been encouraged to implement opioid-free strategies for the management of post-surgical pain. The efficacy of an opioid-free approach to pain management follow microsurgical vasectomy reversal was examined. METHODS: As part of feasibility initiative beginning November 2018, the post-surgical recovery of 57 consecutive patients undergoing microsurgical vasectomy reversal (VR) was managed according to an opioid-free pain management protocol. The opioid-free protocol of Celecoxib 200mg taken orally every 12 hours as required for 7 days was substituted for Percocet® (oxycodone 5mg/acetaminophen 325mg) 1-2 tablets used orally every 8 hours as required (total - 30 tables prescribed). Activity limitation, application of cold compresses and scrotal support was encouraged in all patients. Patients were followed for 6 weeks post vasectomy reversal and surveyed with respect to medication utilization, functional recovery, surgical and medication-related complications. A previously validated visual-analogue scale (VAS), specific to vasectomy reversal, was utilized to evaluate the degree of post-surgical pain during the first 7 days of surgical recovery. RESULTS: Of 57 consecutive vasectomy reversals performed over a 4-month period, 49 (86%) patients were available for follow-up. Mean patient age was 45 years (range:25-65 years) with a mean time of 8.9 years (range:1-26 years) from the original vasectomy. Medication usage: 37 patients used Celecoxib only as prescribed. 4 elected for non-prescription analgesia (3 Acetaminophen, 1 Ibuprofen) and 8 patients reported using no medications for analgesia post-operatively. No patient reported using opioid containing medications. Mean time to cessation of analgesia related medication use was 4.5 days (range:0-30 days). Pain scores (VAS) during recovery:Figure 1 graphically illustrates the pattern and intensity of pain during the first 7 days following vasectomy reversal. Functional recovery: On average, complete pain resolution was achieved in 14 days with full return of normal activities of daily living within 17 days. A mean of 5.6 days off work was required for surgical recovery. Post-surgical complications: Complications during recovery were infrequent and no serious complications were identified. One Celecoxib-use patient reported developing a hematoma that resolved with conservative management. 5 minor - Clavien-Dindo 1 - complications (i.e. suture reaction, wound separation) unrelated to analgesic usage were reported. Among patients with available semen analysis follow up data, patency rates - presence of motile sperm in the ejaculate - were 94% following VR. CONCLUSIONS: An opioid-free strategy to pain management following vasectomy reversal using Celecoxib appears to be well tolerated by patients offering a safe and efficient post-surgical recovery. Analgesia-related complications are rare and bleeding risk does not appear to be elevated.Source of Funding: None