A prospective study to determine the safety and feasibility of opioid-free discharge after percutaneous...

The American opioid epidemic continues and further efforts are needed to reduce unnecessary opioid prescriptions after urologic surgery. This is a pragmatic feasibility study to evaluate the safety and feasibility of opioid-free discharge after percutaneous nephrolithotomy (PCNL) utilizing a nonopioid protocol consisting of preoperative counseling, multimodal analgesics, and detailed postoperative instructions.

A prospective feasibility study (Clinicaltrials.gov: NCT04597619) was conducted at a single institution. All participants underwent single tract stented PCNL. Eligible participants were enrolled prospectively before and after implementation of the nonopioid protocol. Pre-intervention arm participants received opioid prescriptions at the discretion of the provider. Participants in the intervention arm underwent the nonopioid protocol. The primary outcome investigated was discharge following PCNL without a prescription for opioid pain medication. Other outcomes included postoperative pain, symptom questionnaire scores, emergency department (ED) visits for pain, and outpatient telephone calls or requests for prescription refills.

Fourteen participants were enrolled in the pre-intervention group. Of these, 10 (71%) were discharged with opioid prescriptions and 4 (29%) were discharged without opioids. Of the 10 discharged with opioids, 2 (14%) presented to the ED for pain concerns and received a new prescription for opioids. Six participants underwent intervention and received the nonopioid protocol. All participants (100%) in the intervention group were discharged without opioids. None (0%) presented to the ED for pain concerns.

This feasibility study demonstrates that patients undergoing PCNL via a standardized nonopioid pathway can be safely discharged without opioid prescriptions without impact on outpatient resources. Four participants in the pre-intervention group were discharged without opioids based on provider discretion, suggesting that the standard of care to include an opioid prescription may be changing.