Inflatable Penile Prosthesis Patients Treated with Multimodal Analgesia Have Reduced Risk of Prolonged Opioid Dependence
Rutul D. Patel, MBS1, Avery E. Braun, MD2, Architha Sudhakar, MD2, Jacob W. Lucas, MD2, Martin S. Gross, MD3, Jay Simhan, MD2.
1New York Institute of Technology of Osteopathic Medicine, Old Westbury, NY, USA, 2Einstein Healthcare Network, Philadelphia, PA, USA, 3Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
The utilization of multimodal analgesia (MMA) in inflatable penile prosthesis (IPP) surgery has demonstrated durable results in reducing opioid usage and improving pain control in the postoperative period. Rates of opioid dependence following opioid-based (OB) or MMA pain management in penile implant recipients has yet to be defined. We assessed the risk of prolonged narcotic usage following IPP surgery by comparing prior opioid-based management patients with multimodal analgesia patients.
This is a multicenter retrospective review of 344 three-piece IPP recipients who underwent implantation from 12/2014 to 12/2020. A total of 133 patients (38.7%) were managed with an OB regimen while 211 patients (61.4.0%) received MMA. Development of prolonged opioid dependence was defined as active opioid prescriptions 90 days after surgery. Perioperative and postoperative opioid usage was assessed with the Prescription Drug Monitoring Program (PDMP). Patients were excluded if PDMP data was incomplete or if preexisting history of opioid dependence was identified.
Postoperative inpatient narcotic use was higher in the OB group, with substantially more total morphine equivalents (TME) used (41.3 vs 13.8, p<0.001). After discharge, the OB group required greater narcotic refills (31.5% vs 9.8%, p<0.001) and higher total refill TME (276.0 vs 22.3, p<0.001). IPP recipients managed with MMA had an absolute risk reduction of 3.6% in developing opioid dependence (ARR=0.036). More OB patients developed opioid dependence with more recipients (6/133, 4.5%) developing opioid dependence despite smaller OB cohort size. All 6 OB patients with prolonged opioid dependence were primary IPPs. MMA patients who developed prolonged opioid dependence were predominantly complex revision cases (p=0.045). The OB and MMA groups demonstrated similar ages, incidence of chronic pain, and diabetes but differed in BMI (32.0 vs 30.6, p=0.045) and race (p=0.001). Intraoperative factors did not demonstrate statistical significance.
Our series demonstrates that multimodal analgesia recipients have a decreased risk of prolonged narcotics dependence compared to patients managed with opioids alone, particularly after primary IPPs. Substantial differences in opioid use were noted postoperatively between the cohorts, with MMA patients requiring fewer inpatient TMEs and fewer narcotic refills postoperatively.
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