Prolonged Narcotic Use Research Articles

Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients.

Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients' first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level III.

A comparison of perioperative pain control in total shoulder arthroplasty: preoperative tramadol is associated with decreased long-term opiate use when compared with traditional opioids

BackgroundProlonged opiate use has been associated with adverse patient outcomes and high societal costs. While tramadol, an alternative to traditional opiate pain medications, has evidence-based support for the treatment of knee osteoarthritis, no clear guidance exists in the shoulder arthroplasty literature to guide perioperative prescribing practices. MethodsAll patients from a private insurance database who underwent total or reverse shoulder arthroplasty between 2008 and 2015 were identified. These patients were grouped into 3 mutually exclusive cohorts based on perioperative pain management regimes: those who received (1) traditional opiates only, (2) tramadol only, (3) nonopioids only. These groups were compared for length of stay, prolonged opioid use (defined as opioid use >3 months after surgery), emergency department (ED) visits, 90-day readmissions, and medical complication ResultsFrom 2008 to 2015, 5,797 shoulder arthroplasty patients met inclusion criteria for the study. Of those, 498 (8.6%) received pre- and postoperative tramadol, 2001 (34.5%) traditional opioids, and 3289 (56.7%) nonopioids only. Traditional opioid use was weakly associated with a higher risk of minor medical complications (odds ratio [OR] 1.20, confidence interval [CI] 1.00-1.97, P = .048), ED visits (OR 1.22, CI 19 1.03-1.43, P = .017), and 90-day readmission (OR 1.29, 1.03-1.62, P = .025) compared to nonopioid only users. Additionally, these patients had a markedly higher risk of prolonged narcotic use (OR 6.72, CI 5.89-7.68, P < .001). ConclusionsShoulder arthroplasty who received perioperative tramadol were less likely than those who received traditional opioids to require prolonged opiate pain medication. Given the well-established negative consequences of prolonged opiate use and lack of association between tramadol use and medical complications found in the current study, tramadol should be considered in shoulder arthroplasty candidates. However, tramadol is not without its own risks, and the risk of prolonged postoperative narcotic use is still higher within this population compared to those patients who take no opioids. These results should help inform preoperative pain management plans in patients who are likely to undergo eventual TSA. Level of EvidenceLevel III; Retrospective Cohort Study

Preoperative Sedative Use and Other Risk Factors for Continued Narcotic Use After Total Knee Arthroplasty: A Comprehensive Analysis of a Mandatory Database.

Opioids are used for pain control after total knee arthroplasty (TKA) and carry risk for abuse. Mandatory statewide databases have been created to monitor their use. The goal of this study was to identify patient risk factors for prolonged opioid use after TKA. The authors retrospectively reviewed a consecutive series of 676 primary TKA procedures performed between January 2017 and July 2017. Information on fulfillment of narcotic, sedative, benzodiazepine, and stimulant prescriptions was obtained from the Pennsylvania State Controlled Substance Monitoring website 6 months before and 1 year after the procedure. Bivariate and multivariate analyses were used to identify risk factors for the need for a second prescription and opioid use for longer than 6 months. Of this cohort, 30.3% used preoperative opioids, 60.5% filled a second opioid prescription, and 11.8% continued opioid use for longer than 6 months. Patients who had opioid use before the index procedure had more than 3-fold (odds ratio [OR], 3.29; P<.001) increased odds of filling a second opioid prescription and 8-fold (OR, 8.05; P<.001) increased odds of postoperative opioid use for longer than 6 months. Multivariate analysis was used to identify independent risk factors for requiring a second prescription, including discharge to a rehabilitation facility (OR, 2.77), bilateral procedures (OR, 1.88), preoperative narcotic use (OR, 1.70), and younger age (OR, 0.95). Independent risk factors for narcotic use for longer than 6 months included preoperative sedative (OR, 3.30) or narcotic use (OR, 1.49). This study identified several risk factors associated with prolonged narcotic use after TKA, including preoperative sedative use, and determined their relative weight. [Orthopedics. 2021;44(1):e50-e54.].

Preoperative Pain Management: Is Tramadol a Safe Alternative to Traditional Opioids Before Total Hip Arthroplasty?

BackgroundPreoperative opioid use has been associated with worse clinical outcomes and higher rates of prolonged opioid use following lower extremity arthroplasty. Tramadol has been recommended for management of osteoarthritis-related pain; however, outcomes following total hip arthroplasty (THA) in patients taking tramadol in the preoperative period have not been well described. The aim of this study is to examine the effect of preoperative tramadol use on postoperative outcomes in patients undergoing elective THA. MethodsA total of 5304 patients who underwent primary THA for degenerative hip pathology from 2008 to 2014 were identified using the Humana Claims Database. Patients were grouped by preoperative pain management modality into 3 mutually exclusive populations including tramadol, traditional opioid, or nonopioid only. A multivariate logistic regression was used to evaluate all postsurgical outcomes of interest. ResultsTramadol users had an increased risk of developing prolonged narcotic use (odds ratio [OR], 2.17; confidence interval [CI], 1.89-2.49; P < .001) following surgery compared to nonopioid-only users. When compared to traditional opioid use, tramadol use was associated with decreased risk of subsequent 90-day minor medical complications (OR, 0.75; CI, 0.62-0.90; P = .002), emergency department visits (OR, 0.70; CI, 0.57-0.85; P < .001), and prolonged narcotic use (OR, 0.43; CI, 0.37-0.49; P < .001). Traditional opioid use significantly increased length of stay by 0.20 days (P = .001) when compared to tramadol use. ConclusionPreoperative tramadol use is associated with prolonged opioid use following THA but is not associated with other postoperative complications. Patients taking tramadol preoperatively appear to have a lower risk of postoperative complications compared to patients taking traditional opioids preoperatively.

High Parental Anxiety Increases Narcotic Use in Adolescent Patients Following Spinal Fusion.

Parental mental status and behavior may influence postoperative recovery and the use of pain medication. The purpose of this study is to identify if parents with high anxiety are associated with prolonged narcotic use in adolescent patients following posterior spinal fusion surgery. Prolonged narcotic use in this study was defined as opioid use at their first postoperative visit. AIS patients age 11 to 20 years undergoing posterior spinal fusion and a parent were prospectively enrolled. At the preoperative appointment, patients completed the Spence Children's Anxiety Scale and parents completed the State-Trait Anxiety Inventory. High parental anxiety was defined as 1 SD above the normative mean. At the first postoperative visit, patients were asked about medication use. A total of 58 patients (49 females and 9 males) were enrolled. Overall, 29% (17/58) of parents had a high general anxiety trait on the State-Trait Anxiety Inventory and 71% (41/58) had normal general anxiety. Of the patients whose parents had high general anxiety, 47% (8/17) were still taking narcotics at their first postoperative visit compared with 20% (8/41) of patients with normal anxiety parents (P=0.03). Patients with high general anxiety parents were more than twice as likely to still be on narcotics at their first postoperative visit. This information can be used to counsel families on the impact of anxiety on narcotic usage. Level II-prognostic studies-investigating the effect of a patient characteristic on the outcome of the disease.

Opioids and Spinal Cord Stimulators: Pre- and Postoperative Opioid Use Patterns and Predictors of Prolonged Postoperative Opioid Use.

ObjectiveThe aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. MethodsA database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008–2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use. ResultsA total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. ConclusionPatients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.

Opioid Consumption Patterns and the Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Ankle Fracture Surgery

Category:AnkleIntroduction/Purpose:Over the past two decades, the number of opioids dispensed in the United States has nearly tripled. Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use.Statewide Prescription Drug Monitoring Programs (PDMPs) have been implemented to deter overprescribing and help monitor information pertaining to suspected abuse. The purpose of this study was to assess the immediate postoperative opioid consumption patterns as well as the incidence of new prolonged opioid use among opioid naïve patients following ankle fracture surgery.Methods:This was a retrospective review of prospectively collected data. Patients were included if they underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture between October 2016 and September 2017. Patients were excluded if they received any narcotic prescriptions prior to the date of the initial injury. Patient demographics, medical history, fracture pattern, and opioid prescription and consumption details were collected. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill”. The New Jersey PDMP was used to determine all prescriptions of controlled substances filled up to 1 year postoperatively. Prolonged use was defined as filling a postoperative prescription for a controlled substance 90 days after the index procedure. Linear regression analysis was performed to identify independent factors associated with immediate postoperative opioid consumption and repeated to identify factors associated with prolonged use.Results:One-hundred seventy-one patients were included in this study. At the first postoperative visit, patients consumed a median of 24 pills, whereas the median number prescribed was 40. This resulted in an initial utilization rate of 60% and 2,736 pills left unused. Additionally, we found that 18.7% (n=32) of patients required a narcotic prescription after 90 days from the index procedure. There was no statistically significant difference found between specific fracture type (isolated distal fibula, bimalleolar, trimalleolar) and prolonged opioid consumption, however tibial plafond fractures could not be included due to insufficient sample size (n=5). Patients with a self-reported history of depression (p=.094) or diabetes (p=.097) demonstrated marginal correlation with prolonged narcotic use.Conclusion:Our study demonstrated that patients who underwent outpatient surgical fixation of an ankle or tibial plafond fracture were initially overprescribed narcotics by nearly 67%, leaving a significant quantity of pills unused for potential abuse or diversion. 18.7% of originally opioid naïve patients required continued analgesia 90 days after the index procedure, however large variations in consumption rates make it difficult for physicians to predict prolonged narcotic use.

Mood disorders are associated with inferior outcomes of anatomic total shoulder arthroplasty

Background: Mood disorders (MD) have been associated with inferior outcomes after orthopaedic procedures, but little is known about their effect on total shoulder arthroplasty (TSA). Methods: In patients with primary TSA and a minimum of 2 yr clinical and radiographic follow-up, documentation of depression, anxiety, and/or use of a prescription mood-stabilizing drug indicated MD. Prolonged narcotic use was patient-reported consumption at most recent follow-up or filled narcotic prescription within 3 mo in a statewide database. Results: Chronic pain syndromes were more frequent in 24 patients with MD (76%) than in 63 without (1.6%), and narcotic use was higher (54% vs. 13%, respectively). There were no significant differences in range of motion, strength, complications, reoperations, or radiographic complications and none in the amount of improvement for any of the functional parameters. Conclusions: Patients with MD were four times more likely to require narcotics for pain control, although function improved by an amount similar to the control group. Level of evidence: Level III, retrospective comparison study.

Perioperative Narcotic Use and Carpal Tunnel Release: Trends, Risk Factors, and Complications.

Background: The goals of the study were to: (1) evaluate trends in preoperative and prolonged postoperative narcotic use in carpal tunnel release (CTR); (2) characterize risks for prolonged narcotic use; and (3) evaluate narcotic use as an independent risk factor for complications following CTR. Methods: A query of a large insurance database from 2007-2016 was conducted. Patients undergoing open or endoscopic CTR were included. Revision surgeries or patients undergoing median nerve repair at the forearm, upper extremity fasciotomies, or with distal radius fractures were excluded. Preoperative use was defined as narcotic use between 1 to 4 months prior to CTR. A narcotic prescription between 1 and 4 months after surgery was considered prolonged postoperative use. Demographics, comorbidities, and other risk factors for prolonged postoperative use were assessed using a regression analysis. Subgroup analysis was performed according to the number of preoperative narcotic prescriptions. Narcotic use as a risk factor for complications, including chronic regional pain syndrome (CRPS) and revision CTR, was assessed. Results: In total, 66 077 patients were included. A decrease in prescribing of perioperative narcotics was noted. Risk factors for prolonged narcotic use included preoperative narcotic use, drug and substance use, lumbago, and depression. Preoperative narcotics were associated with increased emergency room visits, readmissions, CRPS, and infection. Prolonged postoperative narcotic use was linked to CRPS and revision surgery. Conclusions: Preoperative narcotic use is strongly associated with prolonged postoperative use. Both preoperative and prolonged postoperative prescriptions narcotic use correlated with increased risk of complications. Preoperative narcotic use is associated with a higher risk of postoperative CRPS.

Narcotic use and total hip arthroplasty.

The purpose of this study is to: (1) characterise risk factors for prolonged narcotic use following total hip arthroplasty (THA); (2) examine preoperative and prolonged postoperative narcotic use as independent risk factors for complications following THA. A national database identified primary THA patients from 2007-2015. Preoperative (POU) and prolonged postoperative narcotics users (PPU) were identified. A multivariable logistic regression analysis was utilised to identify any patient-related risk factors for prolonged use, and examined POU and PPU as risk factors for complications following THA. 55,354 THA patients were included, 18,740 (33.8%) POU and 14,996 (27.1%) PPU. Preoperative narcotics use was the most significant factor associated with prolonged postoperative narcotic use. Preoperative and prolonged postoperative use were associated with significantly higher complications postoperatively. Preoperative narcotic use is the most significant patient specific risk factor for prolonged postoperative narcotic use. POUs and PPUs are at a significantly higher risk of postoperative infection and revision surgery.

Narcotics and Knee Arthroscopy: Trends in Use and Factors Associated With Prolonged Use and Postoperative Complications

To (1) examine trends in the prevalence of preoperative and prolonged postoperative narcotic use in patients undergoing knee arthroscopy, (2) characterize factors associated with prolonged narcotic use after knee arthroscopy, and (3) explore the association of preoperative and prolonged postoperative narcotic use with complications after knee arthroscopy. The PearlDiver database was reviewed for patients who underwent knee arthroscopy from 2007 to 2015 with a minimum of 6months' follow up. Patients with preoperative or prolonged postoperative narcotic use were identified and analyzed for trends. Predictors for prolonged postoperative use were identified, and regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 75,372 patients were included, of which 23.9% used narcotics preoperatively and 22.6% used narcotics for a prolonged period postoperatively. There was no statistically significant trend on a year-to-year basis in preoperative (P= .744) or prolonged postoperative (P= .304) narcotic use. The most significant predictor for prolonged postoperative use was preoperative use (OR 5.33, CI 5.11-5.56, P<.0001), with the odds increasing as the number of preoperative prescriptions increased. Preoperative narcotic use was associated with increased emergency department visits (OR 1.25, CI 1.15-1.36, P < .0001), hospital admission (OR 1.15, CI 1.00-1.33, P= .046), and infection (OR 1.31, CI 1.07-1.59, P= .007). Prolonged postoperative narcotic use was associated with subsequent ipsilateral knee arthroscopy (OR 1.64, CI 1.45-1.86, P < .0001) as well as subsequent knee arthroplasty (OR 1.98, CI 1.83-2.14, P < .0001). The results of this study did not show a trend in the use of narcotics, preoperatively or on a prolonged basis postoperatively, during the study period. The degree of preoperative narcotic use is correlated with prolonged narcotic use. The use of narcotics preoperatively and for a prolonged period postoperatively is associated with increased complications. Level IV, case series, therapeutic.

Narcotic Use and Total Knee Arthroplasty

BackgroundAlthough the United States is in the midst of a narcotic epidemic, risk factors for use and the impact of perioperative narcotic use on total knee arthroplasty (TKA) outcomes is ill-defined. MethodsA national database was queried for patients who underwent primary TKA from 2007 to 2015. Patients taking narcotics in the preoperative, and for a prolonged period of time postoperatively, were identified. The risk factors for prolonged narcotic use were analyzed with a regression analysis, in addition to evaluating preoperative and prolonged postoperative use as independent risk factors for short-term and long-term complications. ResultsIn total, 113,337 patients met inclusion criteria, of which 31,733 patients were prescribed narcotics preoperatively and 35,770 patients were prescribed narcotics more than 3 months postoperatively. There are several independent risk factors for prolonged narcotic use postoperatively, the most significant being the number of narcotic prescriptions prescribed preoperatively. Preoperative narcotic use was independently associated with an increased risk of emergency room visits, readmission, infection, stiffness, and aseptic revision. Prolonged postoperative use was also associated with significantly increased rates of infection, stiffness, and aseptic revision. ConclusionPreoperative and prolonged narcotic use following TKA was associated with an increased risk of short-term and long-term complications following TKA. The liberal use of narcotics in the perioperative period should be considered a modifiable risk factor when considering elective TKA.

Risk Factors for Prolonged Narcotic Use Following Arthroscopic Rotator Cuff Repair

Objectives:Narcotics are commonly prescribed for management of acute pain in the early postoperative period following arthroscopic rotator cuff repair (RCR), but little is known about the frequency and risk factors for persistent use. The goal of this study was to determine risk factors for prolonged narcotic use following arthroscopic RCR.Methods:A national insurance database was queried for patients undergoing arthroscopic RCR from 2007-2015 using CPT codes. Prolonged narcotic use was defined as a new prescription for a narcotic pain medication between 3 and 6 months following the procedure. Patients without minimum 6 months’ follow-up were excluded. A multivariate logistic regression analysis was utilized to evaluate risk factors for prolonged narcotic use, including a prescription for narcotics within the 3 months before surgery, age, sex, obesity, tobacco use, alcohol use, depression and inflammatory arthritis. The regression analysis was used to control for demographics and numerous medical comorbidities. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated for each risk factor, with P < 0.05 considered statistically significant.Results:28,331 patients met inclusion and exclusion criteria. 7,543 patients (27%) were characterized as having prolonged narcotic use. Preoperative narcotic use was the most significant risk factor for prolonged postoperative narcotic use (OR 5.4, p < 0.0001). Age < 50 years (OR 1.4), male sex (OR 1.1), obesity (OR 1.1), morbid obesity (OR 1.4), tobacco use (OR 1.8), alcohol use (OR 1.3), inflammatory arthritis (OR 1.5) and depression (OR 2.0) were also all significant risk factors for prolonged postoperative narcotic use [Table 1].Conclusion:More than a quarter of patients undergoing arthroscopic RCR continue to receive narcotic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged narcotic use is the use of preoperative narcotics. Additional risk factors include younger age, male sex, obesity, tobacco and alcohol use, depression and inflammatory arthritis.Table 1.Significant Risk Factors for Prolonged Narcotic Use after Arthroscopic Rotator Cuff RepairVariableOdds Ratio95% CIPPreoperative Narcotic Use5.43[5.22 -5.66]< 0.0001Age < 50 years1.36[1.26 - 1,46]< 0.0001Male Sex1.14[1.10 - 1.19]< 0.0001Obesity (BMI 30-40)1.09[1.04 - 1.14]< 0.0001Morbid Obesity (BMI 40+)1.36[1.28 - 1.45] < 0.0001Tobacco Use1.78[1.70 - 1.87]< 0.0001Alcohol Use1.34[1..22 - 1.46]< 0.0001Inflammatory Arthritis1.52[1.42 - 1.63]< 0.0001Depression1.99[1.91 - 2.08]< 0.0001

Preoperative Narcotic Use as a Predictor of Clinical Outcome

Prognostic Study, Level II (Retrospective review of prospectively collected data). To identify an association between preoperative narcotic use and clinical outcome after cervical arthrodesis. Little data exists regarding the influence that chronic preoperative narcotic use has on clinical outcomes after surgery. Cervical arthrodesis is a common procedure that has a predictably high success rate for relief of radicular pain. In addition, the patient population presenting for this procedure has a high propensity for preoperative narcotic use. Charts and prospectively collected questionnaires concerning the use of pain medication from 91 consecutive patients who underwent cervical arthrodesis for relief of radicular pain by a single surgeon at a single institution were reviewed. Group I consisted of 47 patients who took narcotic pain medication for their radicular pain on a daily basis for greater than 6 months before surgery. Group II consisted of 44 patients who were not on narcotics chronically before surgery. Postoperative narcotic use and patient outcome based on the modified Robinson criteria were assessed. Patients were observed for a minimum of 2 years. Of the group I patients, 16 (34%) continued to require chronic narcotic pain medication up to 2 years after surgery whereas only 3 (7%) of the group II patients required narcotic pain medication past 3 months (P = 0.002). Of the group I patients, 24 (51%) had a good or excellent result after surgery and 15 (32%) had a poor result whereas 38 (86%) of the group II patients had a good or excellent result and no patient had a poor result (P < 0.001). Chronic narcotic use before cervical arthrodesis was found to be associated with continued narcotic use after surgery and worse functional outcomes following surgery. While further studies will be necessary to ascertain if this relationship is generalizable to other orthopaedic procedures and to analyze for potential confounding variables, surgeons may want to counsel their patients about the potential for inferior clinical outcomes if narcotics are used before surgery.

How Small Can We Go? Percutaneous Nephrolithotomy Using 6F Nephroureteral Catheter

To retrospectively examine our percutaneous nephrolithotomy pathway to determine the efficacy of a 6F antegrade nephroureteral catheter (NUC). The records of 99 consecutive patients who underwent percutaneous nephrolithotomy from 1998 to 2000 were reviewed. All patients were admitted the day before percutaneous nephrolithotomy and underwent placement of a nephrostomy tube. The following day, after balloon dilation of the access tract and performance of the procedure through a 30F sheath, an internal-external 6F NUC was left in place. Nephrostograms were performed on postoperative day 1, and, if negative for extravasation or residual stones, the stent was removed. The postoperative parameters included the length of stay, intravenous narcotic use, complications, and time to removal of the indwelling stent. The average procedure time was 103 minutes (range 30 to 300), with a mean stone size of 1.7 cm. The average length of stay was 2.5 days, with postoperative intravenous narcotic use lasting 1.7 days. Of the 99 NUCs placed, 82% were removed by postoperative day 2. Eleven patients had either renal (n = 8) or ureteral (n = 3) extravasation requiring prolonged stenting, and nine had residual stones requiring a second-look procedure. Multivariate analysis demonstrated that prolonged narcotic use, days with an indwelling stent, and longer procedure times correlated significantly with a longer length of stay (P <0.001). The proportion of minor and major complications was 18% and 5%, respectively. The results of our study have indicated that the 6F NUC minimizes postoperative intravenous narcotic use and expedites both recovery and discharge. Because it is the smallest nephroureteral catheter reported to date for this use, we recommend it be incorporated into prospective studies with validated pain questionnaires.