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Opioids and pediatric urology: A prospective study evaluating prescribing habits and patient postoperative pain and narcotic utilization

Published:January 17, 2023DOI:https://doi.org/10.1016/j.jpurol.2022.12.018

      Summary

      Introduction

      Few pediatric urologists believe patients require a majority of the doses of opioids prescribed to them postoperatively. Seeking a better understanding of postoperative pain and analgesia in pediatric urology patients may help reduce opioid over prescription while still adequately managing postoperative pain.

      Objective

      We sought to better understand: 1) the postoperative pain levels experienced by pediatric urology patients, 2) the factors that correlate with postoperative pain and number of opioids consumed following pediatric urologic procedures, and 3) the patients who do not require opioids after surgery.

      Study design

      Pediatric patients undergoing circumcision, inguinal hernia repair, orchidopexy, or hypospadias repair were eligible to participate. Patients were enrolled in the prospective cohort on the day of the procedure. For each of the first 7 postoperative days, patients' parents completed a text message-based questionnaire, quantifying their child's pain level and the doses of pain medication the child consumed.

      Results

      165 participants were enrolled. 57 patients underwent circumcision, 54 underwent orchiopexy, 32 underwent hypospadias repair, and 22 underwent inguinal hernia repair. For all procedure types, pain scores (p < 0.01) and doses of oxycodone consumed were highest on postoperative day one and steadily declined thereafter. Overall, average 7-day pain score (2.02; 0.86–5.14) and doses of narcotics consumed (3.50; 0–5) were low. Patients in each surgical subgroup were prescribed narcotics in excess of what was consumed. There was an average excess of 10.9 doses (0–39.0) for hypospadias repair, 8.6 (1.0–30.0) for circumcision, 9.0 (3.0–21.0) for inguinal hernia repair, and 6.1 (0–22.0) for orchiopexy.

      Discussion

      Overall, reported pain scores and number of narcotics consumed were low regardless of surgery type. Opioids were overprescribed regardless of surgery type.

      Conclusions

      Summary Figure
      Graphical AbstractA. Mean daily pain rating and opioid use by type of surgery, B. Mean daily consumption of opioids by type of surgery, C. Prescription and consumption of oxycodone by surgery type.

      Keywords

      Abbreviations:

      POD (Postoperative day), NSAID (Nonsteroidal anti-inflammatory drug)
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