A Longitudinal Cohort Study of Pain Intensity and Interference After Ureteroscopy for Nephrolithiasis Without Postoperative Opioids

Urology. 2021 Jan;147:81-86. doi: 10.1016/j.urology.2020.09.042. Epub 2020 Oct 10.

Abstract

Objective: To better understand the degree and time to resolution of pain in the postoperative period, we captured patient-reported pain intensity and interference prospectively in patients following ureteroscopy for nephrolithiasis.

Materials and methods: Adults undergoing ureteroscopy for renal/ureteral stones from 11/2018 to 1/2020 were eligible for inclusion. All received nonopioid postoperative pain control. Patients prospectively completed Patient-Reported Outcome Measurement Information System-Pain Intensity and Patient-Reported Outcome Measurement Information System-Pain Interference instruments preoperatively on postoperative day (POD) 0 and via email on POD 1, 7, and 14. Scores are reported as T-scores (normalized to US population, mean = 50) with changes of 5 (0.5 standard deviation) considered clinically significant.

Results: A total of 126 patients completed enrollment at POD 0 (POD 1 = 74, POD 7 = 61, POD 14 = 47). Compared to US means, intensity and interference were significantly different at all time point comparisons (Wilcoxon rank test; all P <.001) except intensity at POD 7 (P = .09) and interference at POD 14 (P = .12). For both, there was a significant difference at each time comparison (repeated measures ANOVA; all P <.05). Increasing age was predictive of lower intensity (Confidence Interval (CI): -0.31 to -0.04; P = .012) and interference (CI: -0.36 to -0.06; P =.01) at POD 1. The presence of a postoperative stent was predictive of higher intensity (CI: 0.68-10.81; P = .03) and interference (CI: 0.61-12.96; P = .03) at POD 7. Increasing age remained a predictor of lower interference at POD 1 on multivariable analysis (CI: -0.46 to -0.01; P = .03).

Conclusion: Pain intensity and interference are elevated immediately, but intensity normalizes by POD 7, while interference remains elevated until POD 14. Age and indwelling ureteral stent influence both intensity and interference.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Analgesics, Non-Narcotic / therapeutic use
  • Female
  • Humans
  • Kidney Calculi / surgery*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pain Measurement / statistics & numerical data*
  • Pain, Postoperative / diagnosis*
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology
  • Patient Reported Outcome Measures*
  • Risk Factors
  • Stents / adverse effects
  • Time Factors
  • Ureteroscopy / adverse effects*
  • Ureteroscopy / instrumentation

Substances

  • Analgesics, Non-Narcotic