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New England Section of the American Urological Association

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A Retrospective Evaluation of a Novel Perioperative Opioid Sparing Protocol for Patients Undergoing Robotic Assisted Laparoscopic Radical Prostatectomy or Nephrectomy
David M. Krok, PharmD, Lisa Rameaka, MD, Henry Cabrera, MD, Joseph Renzulli, MD.
South County Hospital, wakefield, RI, USA.

The over-prescribing of opioid analgesics by healthcare providers has significantly contributed to the national opioid epidemic. The purpose of this study is to evaluate the opioid-sparing effect of a non-opioid perioperative regimen in patients receiving either a robotic assisted laparoscopic prostatectomy or nephrectomy.Methods: A retrospective cohort study was conducted between patients who received an opioid-sparing regimen and those who had not received this regimen. Patients enrolled in the treatment group received a perioperative blister-pack of medications to start three days prior to surgery and seven days postoperatively upon discharge. Average length of stay, numeric pain scores, quantity of opioids utilized in the inpatient post-operative period, the presence of an opioid prescription at discharge, and outpatient 7-day post-discharge phone calls were collected.Results: Of the 97 patients included in the study, 12 patients out of 27 (44.4%) patients in the control group were discharged with an opioid prescription as compared to 2 of 70 (2.9%) patients in the treatment group. There were also significant differences in total oral milligram morphine equivalents utilized while inpatient (49.38 mg vs 17.38 mg) in patients with no history of chronic opioid use, average length of stay (2.11 days vs 1.49 days) and average outpatient pain scores seven days after discharge (3.73 vs 1.67).Conclusion: A non-opioid perioperative regimen can result in similar post-operative pain control and fewer opioid prescriptions being written at discharge. By decreasing the number of patients requiring opioids post operatively, there is the potential to have a positive impact on the opioid epidemic. The greatest impact being the reduction of opioid prescriptions prescribed upon discharge.


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