A prospective study to determine the safety and feasibility of opioid-free discharge after percutaneous nephrolithotomy.

Background: The American opioid epidemic continues and further efforts are needed to reduce unnecessary opioid prescriptions after urologic surgery. This is a pragmatic feasibility study to evaluate the safety and feasibility of opioid-free discharge after percutaneous nephrolithotomy (PCNL) utilizing a nonopioid protocol consisting of preoperative counseling, multimodal analgesics, and detailed postoperative instructions.

Methods: A prospective feasibility study (Clinicaltrials.gov: NCT04597619) was conducted at a single institution. All participants underwent single tract stented PCNL. Eligible participants were enrolled prospectively before and after implementation of the nonopioid protocol. Pre-intervention arm participants received opioid prescriptions at the discretion of the provider. Participants in the intervention arm underwent the nonopioid protocol. The primary outcome investigated was discharge following PCNL without a prescription for opioid pain medication. Other outcomes included postoperative pain, symptom questionnaire scores, emergency department (ED) visits for pain, and outpatient telephone calls or requests for prescription refills.

Results: Fourteen participants were enrolled in the pre-intervention group. Of these, 10 (71%) were discharged with opioid prescriptions and 4 (29%) were discharged without opioids. Of the 10 discharged with opioids, 2 (14%) presented to the ED for pain concerns and received a new prescription for opioids. Six participants underwent intervention and received the nonopioid protocol. All participants (100%) in the intervention group were discharged without opioids. None (0%) presented to the ED for pain concerns.

Conclusions: This feasibility study demonstrates that patients undergoing PCNL via a standardized nonopioid pathway can be safely discharged without opioid prescriptions without impact on outpatient resources. Four participants in the pre-intervention group were discharged without opioids based on provider discretion, suggesting that the standard of care to include an opioid prescription may be changing.