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UPJ INSIGHT Decreased Opioid Use and Equivalent Pain Score Outcomes After Robotic Urologic Surgery

By: Sofia Gereta, BA, MSHCT, University of Texas at Austin Dell Medical School; Nirupama Ancha, BS, MBA, University of Texas at Austin Dell Medical School; Maya Eldin, BS, MPH, University of Texas at Austin Dell Medical School; Elizabeth Blankenship, PA-C, FHM, University of Texas at Austin Dell Medical School; J. Stuart Wolf Jr, MD, University of Texas at Austin Dell Medical School; E. Charles Osterberg, MD, University of Texas at Austin Dell Medical School; Aaron A. Laviana, MD, MBA, University of Texas at Austin Dell Medical School | Posted on: 18 Mar 2024

Gereta S, Ancha N, Eldin M, et al. Decreased opioid use and equivalent pain score outcomes after robotic urologic surgery using a simplified opioid minimization protocol: a safety-net hospital experience. Urol Pract. 2024;11(2):283-292.

Study Need and Importance

The prescription of excess opioids after surgery continues to contribute to the opioid misuse crisis in the US. Numerous perioperative opioid reduction protocols have been proposed, but they are often complex or difficult to implement. We aimed to implement a simplified opioid minimization (OM) protocol after robotic urologic surgery and assessed its effectiveness in a safety-net hospital using postoperative opioid consumption, complications, patient-reported pain, and satisfaction.

What We Found

We performed robotic urologic surgery in 103 consecutive patients at a safety-net hospital. We established an opioid control (OC) cohort from January to May 2021, and then introduced an OM protocol from June to October 2021. On postoperative day (POD) 2 and POD7, we distributed a validated survey to assess pain and satisfaction. We also collected inpatient opioid doses and opioid dispensation records from the Prescription Monitoring Program. With the use of the OM protocol, 30-day opioid use decreased by 68%, and prescriptions at discharge decreased by 53%. Patient pain severity did not vary between the 2 cohorts on POD2 (median [IQR]: OM=3/10 [2-5], OC=3.5/10 [2-6]; P = .5) or POD7 (OM=2/10 [0-3], OC=1/10 [0-3]; P = .8). Moreover, patient satisfaction with treatment remained consistently high. Thirty-day complications were low grade and uncommon across both cohorts.


This study is limited by its single-institution, single-surgeon nature. Furthermore, there is a lack of granularity of data regarding the effectiveness of the transversus abdominis plane block in limiting opioid use and the consumption of dispensed opioid pills at home.

Interpretation for Patient Care

Our simplified OM protocol effectively decreases outpatient opioid prescriptions after minimally invasive urologic surgery without adversely affecting patient satisfaction and pain outcomes. This easy-to-adopt regimen may be well suited for any health system, particularly resource-limited settings seeking to reduce postoperative outpatient opioid prescriptions.