Utilization of Non-narcotic Analgesics and Adjunctive Medications for Postoperative Symptom Relief in Endoscopic Urologic Surgery in Pediatric Patients
Jessica K. Goeller, DO, Fernando A. Ferrer, Jr., MD, Evan M. Roberts, BS, MB(ASCP), John H. Makari, MD.
Children's Hospital & Medical Center/University of Nebraska Medical Center, Omaha, NE, USA.
BACKGROUND: In an era of increasing concern about opiate addiction, many practitioners are beginning to incorporate opioid-sparing approaches to postoperative symptoms. We sought to characterize Pediatric Urologists' utilization of non-narcotic analgesics and adjunctive medications for postoperative symptom relief following endoscopic Urologic surgery in pediatric patients. By doing so, we hoped to identify opportunities for narcotic sparing symptom relief for these procedures. METHODS: The Societies for Pediatric Urology (SPU) 345 Active Members were invited by email to participate in a survey though Survey Monkey® in which respondents were asked to provide demographic data, information about their prescribing patterns for non-narcotic analgesics and adjunctive medications for specific endoscopic case scenarios and their prescribing/administration preferences for specific non-narcotic analgesics and adjunctive medication, focusing on patient age and/or weight parameters. RESULTS: Seventy-two SPU Active Members responded to the survey (21% response rate). Most pediatric urologists utilize acetaminophen, ibuprofen and viscous lidocaine in all pediatric urologic endoscopy case scenarios presented. Anticholinergic medication (e.g. oxybutynin) appears to be utilized more frequently with stent placement or bladder biopsy. Alpha-blockers, phenazopyridine and ketorolac are used less frequently in all scenarios presented. Pediatric urologists utilize acetaminophen, anticholinergic medication and viscous lidocaine more frequently without age or weight restrictions than the other medications presented. Most pediatric urologists do not give non-narcotic analgesics and adjunctive medications preoperatively. CONCLUSIONS: Although the response rate may preclude generalization, pediatric urologists seem to routinely utilize acetaminophen, ibuprofen and viscous lidocaine for analgesia following pediatric urologic endoscopy. Opportunities for incorporating more frequent use of additional non-narcotic analgesics and adjunctive medications for postoperative symptom relief exist. An opportunity for symptom relief may exist in the pre-operative setting; further research into this approach is warranted.
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