MP47-20 DOUBLE-BLIND, PLACEBO-CONTROLLED RANDOMIZED CONTROLLED TRIAL OF NSAID PRIOR TO URETERAL STENT REMOVAL IN PEDIATRIC PATIENTS

Abstract

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-20 DOUBLE-BLIND, PLACEBO-CONTROLLED RANDOMIZED CONTROLLED TRIAL OF NSAID PRIOR TO URETERAL STENT REMOVAL IN PEDIATRIC PATIENTS N. Valeska Halstead, Kyle Rove, Brett Wiesen, Alan Bielsky, and Jeffrey Campbell N. Valeska HalsteadN. Valeska Halstead More articles by this author , Kyle RoveKyle Rove More articles by this author , Brett WiesenBrett Wiesen More articles by this author , Alan BielskyAlan Bielsky More articles by this author , and Jeffrey CampbellJeffrey Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral spasm, common with ureteral stents, is partially mediated by prostaglandins and may be suppressed by cyclooxygenase inhibitors like NSAIDs. Practices currently vary widely for pain management in patients with ureteral stents, sometimes including opioids. We aimed to determine if NSAID given prior to stent removal would reduce postoperative pain. We hypothesized there would be at least a 75% reduction in postoperative severe pain in patients receiving ibuprofen compared to placebo. METHODS: We performed a double-blind, placebo-controlled randomized controlled trial on pediatric urology patients with an indwelling ureteral stent undergoing removal in the operating room from 2014–2019. 20 patients in each arm were needed to achieve 80% power to detect a 75% reduction in the estimated 55% incidence of severe postoperative (α=0.05). Patients ≥4 years old who had a unilateral stent placed after treatment of urolithiasis or ureteropelvic junction obstruction were randomized to NSAID or placebo in a 1:1 ratio at least 15 minutes prior to scheduled stent removal. Patients estimated pain using Faces Pain Scale-Revised (FPS-R) or visual analogue scale (VAS) prior to and 24 hours after stent removal. RESULTS: 254 patients undergoing stent removal were assessed for eligibility and 44 randomized patients were analyzed using intention to treat analysis. The cohorts were demographically similar and received similar anesthesia treatment. There was no significant difference in maximum PACU pain score (p=0.540) or use of in-hospital opioids (p=0.626) between the two groups. No difference was seen in the incidence of severe post-operative pain (p=1.0), thus rejecting our hypothesis. Significant worsened postoperative pain (pain score increases of ≥2 between time points) decreased from 22.7% to 9.1% between placebo and NSAID, but this did not reach significance (p=0.410). CONCLUSIONS: There was no difference in postoperative pain for patients undergoing ureteral stent removal given preoperative NSAID versus placebo. The incidence of severe pain before and after stent removal was low, ranging from 4.5–9.1%. Our study may have been underpowered given the low incidence of severe pain. Research to minimize pain/stress of operations should continue in order to optimize patient outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e831-e831 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information N. Valeska Halstead More articles by this author Kyle Rove More articles by this author Brett Wiesen More articles by this author Alan Bielsky More articles by this author Jeffrey Campbell More articles by this author Expand All Advertisement Loading ...