Preoperative OxybutyninReduces Postoperative Narcotic Use Following Common Pediatric Urology Surgeries
Michael Lin-Brande, MD, Emily Clennon, MD, Nicholas Chakiryan, MD, Aaron Bayne, MD
Oregon Health and Science Univesity, Portland, OR, USA
Background: Urologic surgery involving placement of an indwelling ureteral and/or urethral drain can be associated with significant catheter related bladder pain (CRBP) causing increased morbidity and narcotic medication use. Studies in the adult population have demonstrated preoperative anticholinergics can help with CRBP. We sought to assess if a single dose of oxybutynin given preoperatively reduces immediate postoperative narcotic use in common pediatric urology surgeries.
Methods: This single-institution retrospective study identified pediatric patients who underwent surgery on the urinary tract with concomitant placement of a urethral and/or ureteral drain. The study began as a quality improvement project which represented a practice change of administering a single weight-based dose of oral oxybutynin in the preoperative area prior to surgery. Surgeries were categorized into four major groups: ureteroscopic/upper tract stone intervention, ureteral reconstruction, transvesical procedure, and penile/urethral reconstruction. Patients were excluded if they had neurologic disease that could impair bladder sensation. Use of an anesthesia regional block (ex pudendal or caudal block) and intraoperative narcotic use were recorded. The primary outcome was receipt of post operative narcotic medication. We converted narcotic pain medication into its morphine milligram equivalent (MME) per kilogram of patient weight. Secondary outcome was post operative numeric pain score or Face, Legs, Activity, Cry, Consolability (FLACC) score. Cox regression analysis was used to assess variables associated with post operative narcotic use.
Results: A total of 134 patients were included in our final study population with 42 receiving oxybutynin and 92 who did not. There was no statistical difference between the groups in terms of age, procedure type, anesthesia block, postoperative drain, intraoperative MME/kg, or postoperative pain score (Table 1). Patients who received oxybutynin preoperatively had a significant decrease in post operative narcotic use (19%) compared to those who did not receive oxybutynin (47%), p=0.002. On multivariable logistic regression analysis, preoperative oxybutynin was associated with a 77% reduced risk of receiving postoperative narcotic (OR=0.23, [0.09-0.56 95% CI], p=0.002) (Table 2). On multivariable linear regression analysis for the continuous variable postoperative MME/kg, preoperative oxybutynin was associated with reduced risk of amount of post operative narcotic medication (OR=0.96, [0.92-0.99 95% CI], p=0.02).
Conclusions: A single dose of oxybutynin given preoperatively can reduce the use and amount of narcotic given in the post anesthesia care unit. This relatively low risk intervention can be easily implemented.
Back to 2023 Abstracts