The following is a summary of “Decreased Opioid Prescription with Low Pain Scores After Urethroplasty: Using a Simplified, Multimodal, Opioid Minimization Pain Protocol,” published in the February 2024 issue of Urology by Butler et al.

The objective of this study was to implement and evaluate the efficacy of a streamlined, opioid-minimized, multimodal pain management (MPM) protocol in reducing opioid usage while maintaining low postoperative complications, patient-reported pain levels, and interference with quality of life (QOL) among men undergoing urethroplasty. Over a period from October 2020 to October 2023, a total of 95 men underwent urethroplasty at a single academic center. The researchers conducted a retrospective review of the standard pain management (SPM) cohort before August 2021, followed by a prospective study of the MPM cohort after August 2021. 

Pain scores on postoperative day (POD) 1 were collected from electronic medical records for the SPM cohort, while validated pain and QOL assessments were obtained for the MPM cohort in the early postoperative period. Comparison of POD 1 pain scores from the SPM cohort with POD 2 pain scores from the MPM cohort revealed significantly reduced opioid prescription in the latter, with 75 morphine milligram equivalents (MME) fewer opioids prescribed (0, interquartile range [IQR]: 0-0 vs. 75, IQR: 0-150, p<0.001, respectively).

The percentage of patients receiving opioid discharge prescriptions decreased from 50% in the SPM cohort to 11% in the MPM cohort (p<0.001). Despite the reduction in opioid usage, early postoperative pain scores remained low and comparable between the two cohorts, and pain interference with QOL measures remained minimal. Complications were infrequent in both groups. 

In conclusion, this simplified, multimodal analgesia protocol effectively reduces postoperative pain and opioid consumption without compromising QOL outcomes following urethroplasty. This pain management approach offers a practical solution for decreasing postoperative opioid use in men undergoing urethroplasty and can be readily adopted in clinical practice.

 Source: sciencedirect.com/science/article/abs/pii/S0090429524000827