Elimination of Postoperative Narcotics in Infant Robotic Pyeloplasty Using Caudal Anesthesia and a Non-narcotic Pain Pathway.
Journal of Urology
INTRODUCTION AND OBJECTIVE:
Research suggests that narcotic pain medications are dramatically overprescribed. We hypothesize that narcotics are unnecessary in the majority of infants for postoperative pain control. In this series, we report our experience combining caudal blocks with a non-narcotic postoperative pathway as a means of completely eliminating postoperative narcotics following infant robotic pyeloplasty.
We reviewed 15 consecutive patients under 4 years of age who underwent robotic pyeloplasty by a single surgeon followed by a standardized postoperative non-narcotic pain pathway between May 2017 and October 2020. The standardized postoperative pathway consisted of an end-procedure caudal block followed by alternating IV acetaminophen and ketorolac. We reviewed demographics, outcomes and unscheduled healthcare encounters (office visits, ER visits or readmissions) within 30 postoperative days.
73.3% (11/15) patients were male and average age was 10.8 months (range 4-21 months). 60% (9/15) underwent surgery on the left. 20% (3/15) of patients received a single postoperative dose of narcotic in the PACU. No patient received additional narcotics during their hospitalization. No patient required narcotic prescriptions at discharge or anytime thereafter. Average length of stay was 1.2 days. There were no pain-related unscheduled healthcare visits or phone calls within 30 days of discharge.
This series supports the fact that narcotics are not needed for infants following robotic pyeloplasty. Post-procedure caudal block is likely a good addition to a non-narcotic pathway. In the future, we intend to expand these findings to other pediatric urologic procedures in the hope of eliminating unnecessary narcotic use.
Meier K, Shah M, Banooni A, Liss Z. Elimination of postoperative narcotics in infant robotic pyeloplasty using caudal anesthesia and a non-narcotic pain pathway. J Urol. 2021 Sep;206(3suppl):e798-799.