MP63-02 A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING PAIN OUTCOMES OF OPIOID VS NON-OPIOID ANALGESIA IN PATIENTS UNDERGOING URETEROSCOPY OR PERCUTANEOUS NEPHROLITHOTOMY FOR URINARY STONE DISEASE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP63)1 Apr 2020MP63-02 A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING PAIN OUTCOMES OF OPIOID VS NON-OPIOID ANALGESIA IN PATIENTS UNDERGOING URETEROSCOPY OR PERCUTANEOUS NEPHROLITHOTOMY FOR URINARY STONE DISEASE Matthew S. DeMasi*, Amanda K. Mengotto, Pablo A. Cuartas, Daniel Schoenfeld, and Joshua M. Stern Matthew S. DeMasi*Matthew S. DeMasi* More articles by this author , Amanda K. MengottoAmanda K. Mengotto More articles by this author , Pablo A. CuartasPablo A. Cuartas More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , and Joshua M. SternJoshua M. Stern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000938.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The United States is currently experiencing an epidemic of overdose deaths involving prescription opioids. Opioids are commonly prescribed after urological surgeries, but are associated with high-risk adverse events. In this randomized clinical trial, we aim to determine whether NSAID based pain control is non-inferior to opioid therapy by analyzing pain outcomes after surgical treatment for urinary stone disease (USD). METHODS: Patients underwent ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for USD at our institution in the Bronx, NY. After excluding for renal disease, bleeding disorders, asthma, and peptic ulcer disease, patients were randomized into either Group A (ketorolac) or Group B (acetaminophen/oxycodone). Pain status was evaluated one week postoperatively using an 11-point ordinal rating scale with 5 specific questions regarding postoperative pain outcomes. Data were analyzed using a two-tailed t-test with a non-inferiority margin of maximal acceptable difference in mean scores of 1.3. RESULTS: In this interim analysis, 52 out of the planned 102 patients have completed the study: 28 in Group A (54%) and 24 in Group B (46%). Pain scores in Group A were non-inferior to Group B for each of the 5 assessed pain outcomes (See Table 1). For the overall worst pain intensity level, Group A reported significantly lower pain scores compared to Group B, with respective pain scores of 5.857 ± 3.546 (IQR 6) and 7.875 ± 3.125 (IQR 3.75). This corresponds to a difference in means of -2.018 ± 0.934 (p=0.036; [CI: -3.894 to -0.141]). 10.71% of patients in Group A returned to the ED within 30 days of surgery as compared to 16.67% of patients in Group B (p=0.54). CONCLUSIONS: Pain outcomes of NSAID based therapy were non-inferior to opioid analgesia after surgery for USD, and were shown to be significantly better for worst pain intensity levels. The trial is ongoing, but a large-scale randomized control trial is feasible and warranted to further assess the effectiveness of each medication and to potentially minimize opioid usage after surgery. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e954-e954 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew S. DeMasi* More articles by this author Amanda K. Mengotto More articles by this author Pablo A. Cuartas More articles by this author Daniel Schoenfeld More articles by this author Joshua M. Stern More articles by this author Expand All Advertisement PDF downloadLoading ...