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UPJ INSIGHT Multimodal Pain Control Utilizing Buprenorphine for Robotic-Assisted Laparoscopic Prostatectomy
By: Mohammad Hajiha, MD, Emory University School of Medicine, Atlanta, Georgia; Donna Lien, MD, Loma Linda University Medical Center, California; Jo Ann Johnson, BS, Loma Linda University School of Medicine, California; Ivan Muchiutti, BS, Loma Linda University School of Medicine, California; Jasmine Sran, BS, Loma Linda University Medical Center, California; Alexandra Vacaru, BS, Loma Linda University School of Medicine, California; Akin S. Amasyali, MD, Loma Linda University Medical Center, California; Leonard Soloniuk, MD, Loma Linda University Medical Center, California; Kanha Shete, DO, Loma Linda University Medical Center, California; Sonia Wraich, BS, Loma Linda University Medical Center, California; Brian Hu, MD, Loma Linda University Medical Center, California; Duane D. Baldwin, MD, Loma Linda University Medical Center, California; Ruth Belay, MD, Loma Linda University Medical Center, California; Jonathan Malonado, MD, Loma Linda University Medical Center, California; Mohamed Keheila, MD, Loma Linda University Medical Center, California; Ashley Li, MD, Loma Linda University School of Medicine, California; Gary Stier, MD, Loma Linda University Medical Center, California, Riverside University Health System, Moreno Valley; Justin Calvert, MD, Loma Linda University Medical Center, California, Riverside University Health System, Moreno Valley; Melody Chang, MD, Loma Linda University Medical Center, California; Michael Douglas, MD, Loma Linda University Medical Center, California, Riverside University Health System, Moreno Valley; Aviram Assidon, MD, Loma Linda University Medical Center, California; Herbert Ruckle, MD, Loma Linda University Medical Center, California | Posted on: 27 Nov 2023
Hajiha M, Lien D, Johnson JA, et al. Multimodal pain control utilizing buprenorphine for robotic assisted laparoscopic prostatectomy: a quality improvement comparison to conventional opioid management. Urol Pract. 2023;10(6):665-671.
Study Need and Importance
Between April 2020 and April 2021, 74,000 Americans died of an opioid overdose; therefore, it is essential to investigate different methods to reduce consumption of opioids. It has been shown that patients are at risk of continued opioid use with potential for opioid abuse beyond the recovery period after surgery. Persistent opioid use has been noted to be as high as 13% in opioid-naïve patients postoperatively. Our novel study investigates the potential for buprenorphine to be used as an effective analgesic while reducing the conventional opioid side effects.
What We Found
We compared buprenorphine to conventional opioids for perioperative pain control in patients undergoing robotic-assisted laparoscopic prostatectomy, a widely performed robotic surgical procedure. There was no statistically significant difference in length of stay (1.22 vs 1.33 days, P = .416) and length of surgery (260 vs 268 minutes, P = .592) between the buprenorphine and conventional groups. Importantly, the buprenorphine group had significant reduction in both total intraoperative oral morphine milligram equivalents (9.19 vs 20.15, P < .001) and postoperative day 5 morphine milligram equivalents (15.19 vs 47.91, P = .006; Figure). This was achieved while maintaining similar patient satisfaction for pain control compared to conventional opioids (76.9% vs 57.5%, P = .223).
Limitations
Limitations of our study included a small patient sample size and the retrospective nature of the study. This study was also only performed at a single institution, which further limited the number of patients who qualified for the study. In addition, our patient-administered surveys had a potential of recall bias.
Interpretation for Patient Care
By avoiding a postoperative prescription of conventional opioid analgesics using our novel buprenorphine pathway, we can reduce the risk of sustained postoperative opioid use, opioid addiction, and related side effects that can complicate recovery. Moreover, these data may be used and translated into other surgeries.
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