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Initial Experience with Narcotic-Free Ureteroscopy: A Feasibility Analysis.

Tim Large1, Joshua Heiman1, Ashley Ross1

  • 1Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.

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Narcotic-free ureteroscopy (nf-URS) is a safe and effective alternative to standard ureteroscopy (s-URS), significantly reducing opioid prescriptions. This approach decreases narcotic use in the community without compromising patient pain management.

Keywords:
narcoticsnephrolithiasisopioidssurgeryureteroscopy

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Area of Science:

  • Urology
  • Pain Management
  • Public Health

Background:

  • The United States faces an opioid abuse epidemic, partly fueled by prescription medications.
  • Provider prescription habits may be influenced by concerns over uncontrolled post-surgical pain, patient satisfaction, and staff workload.
  • Limited literature exists on analgesic needs following ureteroscopy (URS) for nephrolithiasis.

Purpose of the Study:

  • To evaluate the safety and efficacy of narcotic-free ureteroscopy (nf-URS).
  • To assess the impact of nf-URS on provider workload.
  • To reduce opioid prescriptions in the context of the ongoing opioid crisis.

Main Methods:

  • Retrospective chart review of 104 patients undergoing URS with post-procedure stenting.
  • Comparison between standard ureteroscopy (s-URS) and narcotic-free ureteroscopy (nf-URS) groups.
  • nf-URS patients received diclofenac instead of hydrocodone or oxycodone, if no contraindications existed.

Main Results:

  • No significant difference in postoperative pain-related calls between nf-URS (17%) and s-URS (19%) groups.
  • Fewer nf-URS patients (10%) sought additional narcotics compared to s-URS (17%).
  • nf-URS led to a substantial reduction in administered opioid dosage (6871.5 mg less morphine equivalent).

Conclusions:

  • Narcotic-free ureteroscopy (nf-URS) is a safe and effective practice.
  • nf-URS significantly decreases the number of circulating narcotics, aiding the fight against opioid addiction.
  • This feasibility study supports broader adoption of nf-URS to combat the opioid epidemic.