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August 14, 2018

Combating a Crisis: IU Health Launches Narcotic-Free Ureteroscopy Surgery

IU Health Methodist Hospital

Combating a Crisis: IU Health Launches Narcotic-Free Ureteroscopy Surgery

Concern over the opioid epidemic prompted an IU Health Methodist team to do what it could to incite change. It is the first in the U.S. to publish a study showing the positive effects of cutting narcotics out of ureteroscopy.

In a groundbreaking move, surgeons at IU Health Methodist Hospital decided to stop prescribing oxycodone and hydrocodone for kidney stone procedures and, instead, gave patients an anti-inflammatory drug.

The mission: see how patients responded to narcotic-free surgery in hopes of combating the opioid crisis by inciting a move to fewer prescribed painkillers.

“It was a big leap to do this,” says Amy Krambeck, M.D., a urologist at Methodist who helped lead the study. “It was kind of going out on a limb.”

From February to May, 51 patients who underwent a ureteroscopy -- the most common procedure to treat kidney stones in which a small scope is inserted into the bladder and ureter -- were given the anti-inflammatory drug diclofenac, rather than narcotics.

Urologiest at Methodist Hospital, Amy Krambeck, M.D.

The biggest concern, says Dr. Krambeck, was that the lack of painkillers would generate more phone calls for nurses and staff, more return trips to the emergency room and that the patients’ pain wouldn’t be controlled. Ureteroscopies can cause intense cramping and discomfort post surgery.

But when patients in the study were compared to those treated during prior ureteroscopies when narcotics were used, there were fewer phone calls to staff and return trips to the ER actually decreased, she says.

Even more hopeful, patients who had undergone previous kidney stone procedures told Dr. Krambeck they preferred the non-narcotic version.

“Anecdotally, they have said this was the best stone surgery they’ve had,” says Dr. Krambeck. “They felt like the narcotics just masked the pain. With this, we are treating the inflammation.”

During the study, nearly 1,400 fewer hydrocodone tablets were prescribed, says Tim Large, M.D., a urologist and endourology fellow at Methodist.

The results from the first-of-its-kind study in the United States were recently published in the “Journal of Endourology.” Read the findings here.

The conclusion read: “Narcotic-free ureteroscopy is achievable, based on this study, with pre-operative counseling, a zero tolerance for providing narcotics, and support from ancillary and supporting staff. By managing patient expectations, along with their pain, and being honest about the unnecessary use of opioids in endoscopic surgery, there appears to be minimal need for narcotic prescriptions after uncomplicated ureteroscopy.”

“We are the first to put it out there,” says Dr. Large. “The first in the clinical ship.”

Dr. Krambeck performs as many as 300 ureteroscopies each year. She says doing them without narcotics is now her standard.

She hopes to begin cutting narcotics out of percutaneous stone removal procedures, as well.

“We are trying to get completely away from narcotics as much as possible,” she says. “I hope this will be adopted for other procedures. Narcotics have been overprescribed in the United States for a long time.”

-- By Dana Benbow, Senior Journalist at IU Health.
Reach Benbow via email or on Twitter @danabenbow.

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