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Recommendations for Opioid Prescribing after Endourological and Minimally Invasive Urological Surgery: An Expert Panel Consensus

Koo, Kevin ; Faisal, Farzana ; Gupta, Natasha ; Meyer, Alexa R ; Patel, Hiten D ; Pierorazio, Phillip M ; Matlaga, Brian R

The Journal of urology, 2020-01, Vol.203 (1), p.151-158 [Periódico revisado por pares]

United States

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  • Título:
    Recommendations for Opioid Prescribing after Endourological and Minimally Invasive Urological Surgery: An Expert Panel Consensus
  • Autor: Koo, Kevin ; Faisal, Farzana ; Gupta, Natasha ; Meyer, Alexa R ; Patel, Hiten D ; Pierorazio, Phillip M ; Matlaga, Brian R
  • Assuntos: Analgesics, Opioid - therapeutic use ; Delphi Technique ; Humans ; Pain Management - methods ; Pain, Postoperative - drug therapy ; Practice Patterns, Physicians' - standards ; United States ; Urologic Surgical Procedures
  • É parte de: The Journal of urology, 2020-01, Vol.203 (1), p.151-158
  • Notas: ObjectType-News-1
    content type line 25
    ObjectType-Feature-4
    ObjectType-Conference-2
    SourceType-Conference Papers & Proceedings-1
    ObjectType-Article-3
  • Descrição: Opioids are frequently overprescribed after surgery. The 2018 AUA position statement on opioid use suggests using the lowest dose and potency to achieve pain control but the lack of procedure specific prescribing guidelines contributes to wide variation in prescribing patterns. To address this gap we aimed to develop opioid prescribing recommendations through an expert panel consensus. The 15-member multidisciplinary expert panel included representatives from 5 stakeholder groups. A 3-step modified Delphi method was used to develop recommendations for postoperative opioid prescribing. Recommendations were made for opioid naïve patients without chronic pain conditions. The panel used oxycodone 5 mg equivalents to define the number of prescribed tablets. Procedure specific recommendations were developed for 16 endourological and minimally invasive urological procedures. The panel agreed that not all patients desire or require opioids and, thus, the minimum recommended number of opioid tablets for all procedures was 0. Consensus ranges were identified to allow prescribed quantities to be aligned with expected needs. The maximum recommended quantity varied by procedure from 0 tablets (3 procedures) to 15 tablets (6 procedures) with a median of 10 tablets. Attending urologists typically voted for higher opioid quantities than nonattending panel members. The panel identified 8 overarching strategies for opioid stewardship, including contextualizing postoperative pain management with patient goals and preferences, and maximizing nonopioid therapies. Procedure specific guidelines for postoperative opioid prescribing may help align individual urologist prescribing habits with consensus recommendations. These guidelines can aid quality improvement efforts to reduce overprescribing in urology.
  • Editor: United States
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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