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Initiative to Reduce Narcotic Prescribing in Robotic Nephrectomy

By: Andrew Goldstein
Posted: Thursday, July 18, 2019

At the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 6502), Ruchika Talwar, MD, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues presented a pain management program that resulted in only about 8% of patients who underwent robotic surgery for urologic cancers being discharged with prescriptions for narcotics. Without this enhanced protocol, 100% would have received prescriptions for narcotics.

“We managed to achieve [pain control after surgery] while still seeing an overwhelming reduction in the amount of opioids we prescribed,” explained Dr. Talwar in a Penn Medicine press release.

A total of 25 patients underwent robotic radical nephrectomy, and 58 underwent robotic partial nephrectomy. In addition, 87 patients underwent robotic radical prostatectomy. The researchers implemented a nonopioid analgesia pathway with escalation options. The patients received oral gabapentin and acetaminophen preoperatively, as well as gabapentin, acetaminophen orally every 8 hours and ketorolac intravenously every 6 hours postoperatively. Patients who complained of persistent pain despite the regimen were given 50 or 100 mg of tramadol every 6 hours for a pain level 5 to 7 or 8 to 10, respectively. If they required further escalation, patients were given 5 or 10 mg of oxycodone on the same scale.

Using this protocol, 67.7% of 170 patients in the program between September 2018 and January 2019 were discharged without opioids. In addition, 24.4% were discharged with 10 pills of tramadol, and 8.2%, with 10 pills of oxycodone. Dr. Talwar and colleagues also found that there was no difference in pain scores among these three groups.

“Every practice is different, and so our next goal is to test this approach in a multi-institutional study,” said senior study author Thomas J. Guzzo, MD, MPH, also of the University of Pennsylvania, in a Penn Medicine press release.

Disclosure: The study authors’ disclosure information may be found at coi.asco.org.



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