Mp06-19 Evaluation of an Opioid-Free Pathway for Perineal Reconstructive Surgery: A 1-Year Pilot Study

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (including stricture) I (MP06)1 May 2024MP06-19 EVALUATION OF AN OPIOID-FREE PATHWAY FOR PERINEAL RECONSTRUCTIVE SURGERY: A 1-YEAR PILOT STUDY Bridget L. Findlay, Elizabeth N. Bearrick, Alexandr M. Pinkhasov, Anthony Fadel, Katherine T. Anderson, and Boyd R. Viers Bridget L. FindlayBridget L. Findlay , Elizabeth N. BearrickElizabeth N. Bearrick , Alexandr M. PinkhasovAlexandr M. Pinkhasov , Anthony FadelAnthony Fadel , Katherine T. AndersonKatherine T. Anderson , and Boyd R. ViersBoyd R. Viers View All Author Informationhttps://doi.org/10.1097/01.JU.0001009452.79331.fd.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to evaluate the impact of a standardized perioperative pain management pathway on postoperative opioid prescribing practices following male perineal reconstructive surgery at our institution. METHODS: Patients undergoing perineal reconstructive surgery (urethroplasty, artificial urinary sphincter, urethral sling, perineal urethrostomy) by a single surgeon from July 1, 2022 to June 30, 2023 were prospectively followed. Standardized nonopioid pathways were implemented based on location (penile vs. perineal) and need for buccal mucosa graft (BMG). Intraoperative local anesthetic included liposomal bupivacaine mixed with 0.25% bupivacaine, injected as pudendal nerve block or dorsal penile nerve block. Opioids are administered in the recovery room at the discretion of anesthesiology providers. As of July 1, 2022, our standard practice does not include a postoperative opioid prescription unless pain is poorly controlled in the recovery area. Postoperative communication encounters and opioid prescriptions were tracked through the electronic health record in order to assess efficacy of an opioid free pathway. RESULTS: 67 patients met criteria during the study period, 64/67 performed in an outpatient setting. Patient demographics are reflected in Table 1. 7/67 (10.4%) patients were prescribed an opioid in the postoperative period; 5 prescriptions were related to post-surgical pain whereas 2 were related to chronic pain. No refills were prescribed. Of the 26 patients who received an opioid in the recovery area, 2 (7.6%) were prescribed an opioid at discharge – 1 for postoperative pain and 1 related to chronic use. 15/67 (22%) patients had a communication encounter related to pain within 30 days, with the majority of these encounters pertaining to bladder spasm management. None of these patients received an opioid at discharge; however, 2 patients were electronically prescribed oxycodone for poorly controlled incisional pain following discharge. CONCLUSIONS: An opioid free pathway is appropriate for opioid naïve men undergoing perineal reconstructive surgery. When necessary, electronic opioid prescribing should be employed following discharge for breakthrough pain. Overall, multimodal pain pathways and perioperative patient counseling should be optimized to further limit postoperative opioid prescribing. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e59 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Bridget L. Findlay More articles by this author Elizabeth N. Bearrick More articles by this author Alexandr M. Pinkhasov More articles by this author Anthony Fadel More articles by this author Katherine T. Anderson More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...