A Multi-institutional Assessment of Multimodal Analgesia in Penile Implant Recipients Demonstrates Dramatic Reduction in Pain Scores and Narcotic Usage
| Autor: | Sarah Christianson, M.M. Osman, Jacob Lucas, Kenneth J. DeLay, Faysal A. Yafi, Jay Simhan, Martin S. Gross, Farouk M. El-Khatib |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Narcotics Narcotic Visual analogue scale Urology Endocrinology Diabetes and Metabolism medicine.medical_treatment Analgesic 030232 urology & nephrology Aftercare Penile Implantation Pacu Cohort Studies 03 medical and health sciences 0302 clinical medicine Endocrinology medicine Humans Pain Management Aged Pain Measurement Retrospective Studies Penile pain Analgesics Pain Postoperative 030219 obstetrics & reproductive medicine biology business.industry Penile implant Middle Aged Opioid-Related Disorders biology.organism_classification Patient Discharge Analgesics Opioid Psychiatry and Mental health Regimen Reproductive Medicine Opioid Anesthesia Analgesia Penile Prosthesis business medicine.drug |
| Zdroj: | The Journal of Sexual Medicine. 17:518-525 |
| ISSN: | 1743-6109 1743-6095 |
| Popis: | Introduction Despite the pain associated with inflatable penile prosthesis (IPP) implantation, there has been a lack of standardized, nonopioid pain control regimens described to date. Aim To assess the effectiveness of a multimodal analgesic regimen in patients undergoing implantation of an IPP compared with patients treated with an opioid-only regimen. Methods A large, multicenter patient cohort undergoing IPP implantation whose pain was managed using a multimodal analgesia (MMA) protocol (preoperative and postoperative acetaminophen, meloxicam orcelecoxib, and gabapentin and intraoperative dorsal and pudendal nerve blocks) was compared with a matched cohort of patients managed via an opioid-only protocol. Both groups were compared with respect to visual analog score (VAS) and opioid usage (total morphine equivalents [TME]) in the post-anesthesia care unit (PACU), postoperative day 0 (POD0) and postoperative day 1 (POD1), and in the immediate postdischarge period. Narcotic usage on discharge and follow-up were assessed and compared. Main Outcome Measure Postoperative pain scores and narcotic usage are the main outcome measures. Results 203 patients were eligible for final analysis: 103 (50.7%) patients receiving MMA medication and 100 (49.3%) patients receiving opioids only. The VAS was significantly lower in the multimodal group in PACU (median 0.0 vs 2.0, P = .001), POD0 (median 3.0 vs 4.0, P = .001), and POD1 (median 3.0 vs 4.3, P = .04). Patients in the multimodal group also used fewer narcotics in PACU (median 0.0 vs 4.0 TME, P = .001), POD0 (median 7.5 vs 12.5 TME, P Clinical Implications MMA confers significant improvement in pain management while also providing a significant reduction in narcotic usage in patients undergoing implantation of IPP. Strength & Limitations This is the 1st large multi-institutional assessment of a multimodal analgesic regimen in urologic prosthetic surgery. The analgesic regimen targets several pain pathways that provide excellent pain control throughout the recovery process. Limitations include retrospective design and lack of standardization of the nonsteroidal anti-inflammatory drug type within the multimodal analgesic regimen. Conclusion The use of a MMA protocol significantly reduces postoperative pain measures in penile implant recipients and further reduces both inpatient and outpatient narcotic usage without any discernable side effects. |
| Databáze: | OpenAIRE |
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