Ketorolac a preferable choice to narcotics for pain relief in post-ureteroscopy patients: Study

Pain is one of the major causes of unprecedented emergency department visits and readmissions after ureteroscopy, making postoperative analgesic stewardship is a grave matter to look into amid the current opioid epidemic.

A group of researchers from U.S.A. conducted a double-blinded, randomized controlled trial, with noninferiority design, comparing nonsteroidal anti-inflammatory drugs to opiates for postoperative pain control in patients undergoing ureteroscopy for urolithiasis.

The researchers randomly divided the total 81 participants in either oxycodone (5 mg) (n=43) group or ketorolac (10 mg) (n=38) group, both the medicines to be taken as needed, with 3 nonblinded oxycodone rescue pills for breakthrough pain. The 2 groups had comparable patient, stone, and perioperative characteristics.

The primary study outcome was visual analogue scale pain score on postoperative days 1–5.

While secondary outcomes included medication utilization, side effects, and Ureteral Stent Symptom Questionnaire scores.

The results of the study are as follows:

No differences were found in postoperative pain scores, study medication or rescue pill usage, or side effects.

Higher maximum pain scores on days 1–5 and higher questionnaire scores correlated with analgesic usage, irrespective of treatment group. Patients receiving ketorolac reported significantly fewer days confined to bed.

There was no difference in unscheduled postoperative physician encounters.

The researchers concluded that this was the first double-blinded randomized controlled trial comparing nonsteroidal anti-inflammatory drugs and opiates post-ureteroscopy, and it demonstrated noninferiority of nonsteroidal anti-inflammatory drugs in pain control with similar efficacy, safety profile, physician contact and notably, earlier convalescence as compared to the opioid group. Thus, providing a piece of strong evidence against routine opioid use post-ureteroscopy, justifying continued investigation into reducing postoperative opiate prescriptions.

Reference:

A study titled, "SKOPE—Study of Ketorolac vs Opioid for Pain after Endoscopy: A Double-Blinded Randomized Control Trial in Patients Undergoing Ureteroscopy" by Fedrigon D published in The Journal of Urology.

https://doi.org/10.1097/JU.0000000000001772