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Ultra-Restrictive Opioid Prescription Protocol After Inflatable Penile Prosthesis.

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An ultra-restrictive opioid prescription protocol (UROPP) significantly reduced opioid use and prescribing after inflatable penile prosthesis (IPP) surgery without increasing emergency visits. This approach aids in combating the opioid epidemic by minimizing unnecessary prescriptions.

Keywords:
inflatable penile prosthesismulti-modality pain managementopioidspain managementpenile prosthesis

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Area of Science:

  • Urology
  • Pain Management
  • Public Health

Background:

  • The opioid epidemic necessitates reduced opioid overprescription, particularly challenging for urologic surgeons managing postoperative pain after procedures like inflatable penile prosthesis (IPP) placement.
  • This study addresses the need for effective pain management strategies following IPP surgery while curbing opioid misuse.

Purpose of the Study:

  • To evaluate the impact of an ultra-restrictive opioid prescription protocol (UROPP) on pain control and opioid consumption in patients undergoing IPP surgery.
  • To compare opioid usage and patient outcomes between a UROPP cohort and a historical control group.

Main Methods:

  • A perioperative ultra-restrictive opioid prescription protocol (UROPP) was implemented, involving scheduled acetaminophen and ketorolac, with opioids reserved for breakthrough pain.
  • Patients received limited opioid prescriptions at discharge, alongside non-opioid analgesics. Data were compared to a retrospective cohort treated before UROPP implementation.
  • Outcomes included total morphine milligram equivalents (MMEs), number of opioid pills prescribed, and rates of refills or emergency visits.

Main Results:

  • Implementation of the UROPP significantly decreased opioid prescribing at discharge (100% vs. 36%), reduced median opioid pills (19.0 vs. 0.0), and lowered total MMEs.
  • No significant increase in 30-day emergency department visits was observed post-UROPP implementation.
  • Inpatient UROPP patients showed the highest reduction in opioid discharge, with 96% leaving without opioids and maintaining low refill rates.

Conclusions:

  • The UROPP is a feasible and effective strategy for reducing opioid prescribing after IPP placement.
  • This protocol helps mitigate the risks associated with unnecessary opioid prescriptions and potential abuse.
  • The findings support the adoption of UROPP in urologic surgery to address the opioid crisis.