Preoperative Oxybutynin Reduces Postoperative Opioid Use Following Common Pediatric Urology Surgeries

No AccessJournal of UrologyPediatric Article31 Jul 2024Preoperative Oxybutynin Reduces Postoperative Opioid Use Following Common Pediatric Urology SurgeriesThis article is commented on by the following:Editorial CommentEditorial Comment Michael Lin-Brande, Nicholas H. Chakiryan, and Aaron P. Bayne Michael Lin-BrandeMichael Lin-Brande Corresponding Author: Michael Lin-Brande, MD, 3303 S Bond Ave, Building 1, 10th Floor, Portland, OR 97239 ([email protected]) , Nicholas H. ChakiryanNicholas H. Chakiryan Department of Urology, Oregon Health & Science University, Portland, Oregon , and Aaron P. BayneAaron P. Bayne Department of Urology, Oregon Health & Science University, Portland, Oregon View All Author Informationhttps://doi.org/10.1097/JU.0000000000004162AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Urologic surgery involving placement of an indwelling ureteral and/or urethral drain can be associated with significant catheter-related bladder discomfort causing increased postoperative morbidity and opioid medication use. We sought to assess if a single dose of oxybutynin given preoperatively reduces immediate postoperative opioid use in common pediatric urology surgeries. Materials and Methods: This single-institution retrospective study identified pediatric patients who underwent surgery on the urinary tract with concomitant placement of a urethral and/or ureteral drain. Patients were given a single weight-based dose of oral oxybutynin in the preoperative area prior to surgery. The primary outcome was receipt of postoperative opioid medication. Multivariable regression analyses were used to assess variables associated with postoperative opioid use. Results: A total of 134 patients were included in our final study population with 42 receiving oxybutynin and 92 who did not. There was no statistical difference between the groups in terms of age, procedure type, anesthesia block, postoperative drain, or intraoperative morphine milligram equivalents per kilogram. Patients who received oxybutynin preoperatively had a decrease in postoperative opioid use (19%) compared to those who did not receive oxybutynin (47%). On multivariable logistic regression analysis, preoperative oxybutynin was associated with a 77% reduced risk of receiving postoperative opioid (odds ratio 0.23, [95% CI 0.09-0.56], P < .001). Conclusions: For pediatric patients with an indwelling urinary drain after urologic surgery, a single preoperative dose of oxybutynin was significantly associated with lower postoperative utilization of opioids. This relatively low risk intervention can be easily implemented. REFERENCES 1. . Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth.2006; 96(3):377-380. doi: 10.1093/bja/ael003 Crossref, Medline, Google Scholar 2. Sanofi-Aventis. Ditropan (oxybutynin) [package insert]. U.S. Food and Drug Administration. Revised February 2008. Accessed January 15, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017577s034,018211s017,020897s018lbl.pdf Google Scholar 3. . Oxybutynin. In: StatPearls. StatPearls Publishing; 2023. Google Scholar 4. . The FLACC: a behavioral scale for scoring postoperative pain in young children. 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Urology.2018; 113:192-196. doi: 10.1016/j.urology.2017.11.006 Crossref, Medline, Google Scholar Recusal: Dr Chakiryan is a reviewer board member of The Journal of Urology® and was recused from the editorial and peer review processes. Dr Seideman, AUA publications online content editor, was recused from the editorial and peer review processes due to affiliation with Oregon Health & Science University. Funding/Support: None. Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. STUDY00025503). Author Contributions: Conception and design: Lin-Brande, Bayne. Data acquisition: Lin-Brande. Data analysis and interpretation: Chakiryan, Bayne. Drafting the manuscript: Lin-Brande. Critical revision of the manuscript for scientific and factual content: Chakiryan, Bayne. Statistical analysis: Lin-Brande, Chakiryan. Supervision: Chakiryan, Bayne. Data Availability: The datasets generated during the current study are available from the corresponding author on reasonable request. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiemens D and Routh J Editors' ChoiceJournal of Urology, Dos Santos J, Rickard M and Lorenzo A Editorial CommentJournal of Urology, Keefe D Editorial CommentJournal of Urology, Related articlesJournal of Urology2 Aug 2024Editorial CommentJournal of Urology2 Aug 2024Editorial Comment Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordscatheter-related bladder discomfortureteral stenturethral catheterbladder spasmoxybutyninopioidMetrics Author Information Michael Lin-Brande Corresponding Author: Michael Lin-Brande, MD, 3303 S Bond Ave, Building 1, 10th Floor, Portland, OR 97239 ([email protected]) More articles by this author Nicholas H. Chakiryan Department of Urology, Oregon Health & Science University, Portland, Oregon More articles by this author Aaron P. Bayne Department of Urology, Oregon Health & Science University, Portland, Oregon More articles by this author Expand All Recusal: Dr Chakiryan is a reviewer board member of The Journal of Urology® and was recused from the editorial and peer review processes. Dr Seideman, AUA publications online content editor, was recused from the editorial and peer review processes due to affiliation with Oregon Health & Science University. Funding/Support: None. Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. STUDY00025503). Author Contributions: Conception and design: Lin-Brande, Bayne. Data acquisition: Lin-Brande. Data analysis and interpretation: Chakiryan, Bayne. Drafting the manuscript: Lin-Brande. Critical revision of the manuscript for scientific and factual content: Chakiryan, Bayne. Statistical analysis: Lin-Brande, Chakiryan. Supervision: Chakiryan, Bayne. Data Availability: The datasets generated during the current study are available from the corresponding author on reasonable request. Advertisement PDF downloadLoading ...