Login to Access Video or Poster Abstract: MP66-03
Sources of Funding: none

Introduction

Morrison’s survey of SPU members reported no clear consensus in managing peri-operative pain in pediatric patients undergoing common urological procedures. We posit that non-narcotic analgesia allows withholding narcotic use following simple urologic surgery in out-patient surgery in most patients. _x000D_

Methods

We prospectively tracked analgesic use and pain scales of patients undergoing outpatient penile (non-hypospadias) or groin surgery (hernia, orchidopexy). Parents marked an analgesic usage form and Wong-Baker FACES pain scale on the day of surgery (DOS) and post-operative day 1 (POD1). Patients received a caudal nerve block, unless contraindicated or refused by parents, or a penile block. Postoperative analgesics were either non-narcotic agents or narcotics prescribed at surgeon’s discretion. Descriptive statistics, contingency table analyses, and t-test were performed. _x000D_

Results

249 male patients, median age 36 mo (2-216mo) underwent penile (64%) or groin (36%) surgery. Caudal (92) or local block (147) was used in 96% of cases. Narcotics prescribed in 152 (61%) was associated with older age (74mo vs 47mo; p =0.0002). Overall, no difference in analgesic use was noted (p=NS) on DOS (72%) and POD (62%) and were not affected by surgery or block type._x000D_ Among patients prescribed narcotics, 76% used any analgesic on DOS and 66% on POD 1 (p=NS); narcotic use on DOS (91 cases - 65 took 1 dose) declined on POD1 (57; p=0.0001) and was unaffected by surgery type or block type. Analgesic type used was similar between surgery types and between DOS and POD1 regardless of block used. Among patients not prescribed narcotics, 72% took 1+ doses of analgesics on DOS which declined to 59% on POD 1 (p=NS); usage was similar based on surgery type and from DOS to POD1 for both surgery and block types. Pain scale differences were not significant on DOS between non-narcotics and narcotic users (3.2 v 3.6, p=NS) but were on POD 1 (2.8 v 3.6, p=0.0003). Pain significantly decreased for those using non-narcotics between DOS and POD1 (p=0.004) but not for those using narcotics, perhaps due to pain perception in older children._x000D_

Conclusions

Narcotic availability leads to its usage following uncomplicated urologic surgery. Given the efficacy of non-narcotic analgesics, and the associated costs and potential side effects, prescribing narcotics should be highly selective.

Funding

none