Unveiling the impact of opioid-free postoperative regimens in ureteroscopy: a comprehensive systematic review and meta-analysis.

Autor:	Terada BD; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil., Gonçalves FG; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil., Porto BC; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil., Duarte Silva B; Specialized Center for Urology, German Hospital Oswaldo Cruz, São Paulo, Brazil., Passerotti CC; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil.; Specialized Center for Urology, German Hospital Oswaldo Cruz, São Paulo, Brazil., Sanderberg RA; Hapvida NotreDame Intermédica, São Paulo, Brazil., Artifon EL; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil., Otoch JP; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil., da Cruz JA; Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, Brazil - arnaldoshiomi@yahoo.com.br.; Specialized Center for Urology, German Hospital Oswaldo Cruz, São Paulo, Brazil.; Ninth of July University, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Minerva urology and nephrology [Minerva Urol Nephrol] 2024 Oct; Vol. 76 (5), pp. 545-553.
DOI:	10.23736/S2724-6051.24.05824-5
Abstrakt:	Introduction: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are minimally invasive urologic procedures that are commonly used to treat kidney stones. However, they often result in significant postoperative pain. Historically, patients undergoing these surgeries have predominantly been managed with opioids, which has contributed to the escalating global complications associated with these drugs, including abuse and addiction. As a result, over the recent years, many healthcare centers have made efforts to minimize opioid use, opting instead for safer alternative medications. In this study, we aim to compare the efficacy of both opioid and opioid-free pain management regimens following URS or RIRS procedures. Evidence Acquisition: A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, LILACS, and Google Scholar. We included studies that compared opioid-based and opioid-free postoperative care for managing pain in patients who underwent URS or RIRS for lithotripsy. Our primary outcome of interest was the frequency of postoperative emergency department (ED) visits. Secondary outcomes included pain-related phone calls, postoperative unexpected encounters, need for opioids at discharge, and patients with opioid refills. Evidence Synthesis: We retrieved 10 articles, encompassing 6786 patients in the opioid group and 5276 patients in the opioid-free group. Overall, our findings lean towards favoring the opioid-free regimen, revealing notable differences between the groups. Opioid-free regimen was associated with less ED visits (OR=0.67; 95% CI: 0.58, 0.77; P=0.00001; I 2 =0%) and required less opioids at discharge (OR=0.11; 95% CI 0.02, 0.64; P=0.01; I 2 =89%). Conclusions: Through statistically superior results, our meta-analysis suggests that an opioid-free regimen outperforms the use of opioids after URS or RIRS, particularly in terms of pain management.
Databáze:	MEDLINE
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