Achieving Opioid-free Postoperative Pain Control in Pediatric Urologic Surgery

Postoperative opioid prescriptions have been implicated as a factor contributing to the national epidemic of opioid-related morbidity and mortality in both adults and pediatric patients. In outpatient urological surgery, opioid prescriptions may be minimized, and even eliminated, without increasing unplanned encounters or adversely affecting quality of life during the recovery period.

Members of the Division of Urology at Children’s Hospital of Philadelphia (CHOP) recently completed a study that measured the efficacy of an opioid-free pain management protocol incorporated into our team’s postoperative care algorithm. The study found that implementation of opioid-free outpatient urologic surgery pathways spanning the patient care continuum nearly eliminated opioid utilization without compromising patient pain control, recovery and quality of life.

The study analyzed children who had undergone ambulatory pediatric urologic surgery at our hospital. Opioid prescriptions decreased from 44% to 2% in the most recent time period analyzed without an increase in unplanned patient encounters and confirming high patient satisfaction. From these results, we concluded that opioid-free postoperative pain control may be achieved in pediatric urologic surgery.

Structured physician peer comparison, EHR redesign and a standardized pain management protocol was implemented for urologic surgery. The protocol streamlined care pathways across the cohort in all surgical phases of care, while monitoring pain reduction, safety and familial satisfaction through patient reported outcomes. Rate of opioid prescriptions per month, utilization of non-opioid medication, unplanned encounters in the emergency department and/or office during implementation were aggregated. Opioid doses and prescribed opioid days before and after protocol implementation were analyzed.

For more information about our research and how opioid prescriptions and utilization may be minimized without increasing unplanned encounters or adversely affecting quality of life, contact CHOP Urology at 215-590-2754.

Related research: Reducing Narcotic Prescriptions Following Lesion or Cyst Excision Surgery

For patients and families: Pain Management After Urology Procedures