Non-opioid analgesia as effective as opioid analgesia after kidney stone surgery

In a new study conducted by Mathew Demasi and colleagues, it was shown that after kidney stone surgery, non-opioid analgesia (Ketorolac) is not inferior to opioid analgesia (acetaminophen/oxycodone).

The findings of this study were published in the Journal of Urology.

Opioids are frequently used to treat postoperative pain. Non-narcotic options are increasingly being utilized to minimize opioid consumption. This paper presents the findings of a randomized clinical trial evaluating non-opioid therapy to opioid therapy following nephrolithiasis surgery.

Between July 2018 and May 2021, patients having elective ureteroscopy or percutaneous nephrolithotomy were randomly assigned to either Ketorolac (Group A) or Acetaminophen/Oxycodone (Group B) (Group B). One week after surgery, each patient was queried by phone to measure pain results using an 11-point ordinal rating scale questionnaire. Patient demographics, surgery factors, pill count, constipation frequency, and any adverse effects were also recorded. To compare pain ratings between groups, a non-inferiority analysis was done using the Mann-Whitney U-Test with a non-inferiority margin of 1.3.

The key findings of this study were as follow:

1. A total of 90 patients had complete data, with 44 (49%) in group A and 46 (51%) in group B.

2. In terms of demographics, kind of stone removal operation, whether or not a stent was put, and stone burden, both groups were comparable.

3. At one week, the total reported pain levels were similar in both groups, suggesting that group A was not inferior to group B.

4. Group A had considerably lower average pain scores and the lowest pain intensity levels.

5. There was no statistically significant difference between groups in terms of unused pills or constipation.

Urologists are acutely aware of the need of avoiding drugs following surgery wherever feasible, and several groups have implemented opioid-sparing or opioid-avoiding protocols. However, if these approaches for kidney stone surgery have not previously been created, this study should serve to justify their decision. Patients having kidney stone surgery will benefit from these initiatives as well. This study adds to the growing body of data that non-opioid analgesics, such as Ketorolac, are a viable alternative for pain control following non-invasive urologic operations.

Reference:

Demasi, M., Segall, M., Feiertag, N., Mengotto, A., Cuartas, P., Loloi, J., Ahn, J., Stern, J., Laudano, M., & Watts, K. (2022). MP31-01 MINIMIZING NARCOTICS: A RANDOMIZED-CONTROLLED TRIAL COMPARING PERCOCET TO KETOROLAC AFTER KIDNEY STONE SURGERY. In Journal of Urology (Vol. 207, Issue Supplement 5). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ju.0000000000002580.01