A Retrospective Review Demonstrating the Feasibility of Discharging Patients Without Opioids After Ureteroscopy and Ureteral Stent Placement.

PURPOSE: Efforts have begun to implement nonopioid protocols for outpatient urologic surgery. In this study, we report a retrospective review of the feasibility of implementing a nonopioid protocol to manage postoperative pain after ureteroscopy with stent placement.

METHODS: Between November 2016 and March 2018, 210 patients underwent ureteroscopy with stent placement by a single surgeon at an academic medical center. A treatment algorithm was used to determine the eligibility and appropriately select patients for the nonopioid pathway. Frequency of postoperative events was reviewed and included visits to the emergency department (ED), telephone calls to the clinic, and requests for prescription refills.

RESULTS: Two hundred six of 210 patients met the inclusion criteria. Of these 206 patients, 151 were discharged without opioid medications (73%) and 55 received opioids (27%). Both patients receiving opioids and nonopioids had a low number of postoperative visits to the ED for genitourinary-related concerns (7 patients receiving opioids [13%] and 15 patients without opioids [10%]). Telephone calls made to the urology clinic for concerning symptoms were made by 25 patients receiving opioids (45%) and 32 patients without opioids (21%). The number of pain medication refill requests was low for both groups: 13 patients receiving opioids (24%) and 11 patients without opioids (7%).

CONCLUSIONS: Our experience using a nonopioid pathway after ureteroscopy and stent placement reveals that approximately three-fourths of patients can be discharged without opioids. Patients had a low number of visits to the ED for postoperative genitourinary symptoms, a low number of telephone calls to the clinic, and requested few prescription pain medication refills regardless of whether or not they received opioids on discharge.