Reducing Opioid Prescriptions in Outpatient Pediatric Urological Surgery

J Urol. 2019 May;201(5):1012-1016. doi: 10.1097/JU.0000000000000020.


Purpose: We assessed the impact of a 2-phase Plan-Do-Study-Act cycle to decrease opioid prescriptions following pediatric urological surgery.

Materials and methods: Parents of children undergoing outpatient urological procedures were given questionnaires to assess opioid dosing and pain scores using the Parents' Postoperative Pain Measure scale. Age, procedure and opioid prescription data were recorded, as well as volume of medication administered. During the first phase of data collection children received an opioid prescription for 10 doses. In the second phase opioid prescriptions were reduced by 50%. Nonparametric tests and Fisher exact test were used for analysis.

Results: Of 250 eligible children 98 (39%) with a median age of 3.0 years (IQR 7.0) participated. In the 81 patients prescribed opioids a median of 2 doses (IQR 3.6) were used in the preintervention and postintervention groups (p = 0.68). Using nonparametric statistical testing, no significant differences were found between pain scores in the 5-dose group (31 patients) and the 10-dose group (24 patients; p = 0.05 for day 1, p = 0.07 for day 2, p = 0.06 for day 3). There was no association between age and percent opioid used (p = 0.83). There were no significant differences in median pain scores or median doses among procedure types.

Conclusions: In outpatient pediatric surgical practice opioid prescriptions can be decreased without increasing pain scores. Physician prescribing practices may contribute more to opioid consumption than actual pain patterns.

Keywords: analgesics; opioid; pain; pediatrics; postoperative; urologic surgical procedures.

MeSH terms

  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / methods*
  • Analgesics, Opioid / administration & dosage*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Databases, Factual
  • Drug Utilization / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Outpatients / statistics & numerical data
  • Pain Management / methods
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Pediatrics
  • Risk Assessment
  • Treatment Outcome
  • Urologic Surgical Procedures / adverse effects*
  • Urologic Surgical Procedures / methods


  • Analgesics, Opioid