MP47-02 ELIMINATING OPIOIDS IN OUTPATIENT PEDIATRIC SURGERY

Abstract

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-02 ELIMINATING OPIOIDS IN OUTPATIENT PEDIATRIC SURGERY Matthew Sims, Paige Hargis, and Elizabeth Malm-Buatsi Matthew SimsMatthew Sims More articles by this author , Paige HargisPaige Hargis More articles by this author , and Elizabeth Malm-BuatsiElizabeth Malm-Buatsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In recent years, use of opioid prescriptions has undergone increasing scrutiny worldwide. In the pediatric urology population, there has been limited research on decreasing post-operative opioid prescriptions, but no studies utilize a zero-opioid approach. We recently performed a retrospective study of 242 patients at our institution, in which no patient received opioids at discharge. Only 2.1% called about post-op pain. In this prospective study, we aim to assess eliminating opioids in postoperative pain control as part of a multimodal approach in pediatric patients undergoing same-day urologic surgery. METHODS: After IRB approval was obtained, patients aged 6 months to 12 years-old undergoing common outpatient urologic procedures were treated with a multimodal approach for post-op pain management that did not include narcotics. This did involve comprehensive parent education, intra-operative local anesthesia, ice packs, bacitracin ointment for penile cases, and acetaminophen and ibuprofen prescriptions at discharge. Parents were contacted on post-op day (POD) 2 and POD7 to inquire about the child’s pain and parent satisfaction. To assess pain, we used validated pain surveys: Parents’ Post-operative Pain Measure (PPPM) for children over 2 years and the Face-Legs-Activity-Cry-Consolability (FLACC) for children under 2 years. Parent satisfaction regarding pain control, prescription practices, and expectations was evaluated with a Likert scale. RESULTS: 120 patients were included in the study from March to November 2020. We received responses from parents of 95 patients (79.2% response rate). On POD2, 6/95 (6.3%) patients had clinically significant pain, as determined by responses to PPPM or FLACC. 7 days after surgery, 2/92 (2.2%) reported clinically significant pain. However, those two patients had pain not directly related to the surgical site: a diaper rash in one patient and the other patient with urethral pain from accidental catheter pull. None of our patients ever required narcotic pain medications. Average parent satisfaction with pain control was 4.86/5.0. CONCLUSIONS: We found that post-op pain in pediatric patients undergoing outpatient urologic surgery can be successfully managed without opioid pain medication and with excellent parent satisfaction. This is the first study of its kind to assess zero-opioid prescribing in this patient population and should give pediatric urologic surgeons the confidence needed to forego narcotics in these patients. This approach is successful when coupled with a comprehensive parent education, expectation management, and multi-modal therapy. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e823-e823 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Sims More articles by this author Paige Hargis More articles by this author Elizabeth Malm-Buatsi More articles by this author Expand All Advertisement Loading ...