LAUSR

INTRODUCTION AND OBJECTIVE: Multimodal pain regimens have shown to decrease narcotic use and hospital stay after surgical procedures. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used, though some argue that use NSAIDs can increase the risk of post-operative bleeding complications. We sought to assess the use of scheduled ketorolac for patients undergoing robotic assisted simple prostatectomy (RASP) on post-operative narcotic utilization and complications. METHODS: Retrospective review of data from single institution of all RASPs (11/2017 to 7/2019) was performed. Prior opioid use was defined as any opioid use for 1 month or longer prior to surgery. Scheduled ketorolac post-operatively was given at surgeon discretion for maximum duration of five days per hospital protocol. The primary outcome was morphine equivalent use in the post-operative period on the floor until discharge. Secondary outcomes were blood transfusion rate and overall complication rate in ketorolac and standard analgesic groups. Multivariable linear regression modeling was used to evaluate the association of scheduled ketorolac use with post-operative narcotic use. RESULTS: There were 207 patients who met inclusion criteria. 143 (69%) patients received scheduled post-operative ketorolac. Fourteen patients were prior opioid users (7%). There was no significant difference in length of stay between groups (Table 1). Median morphine equivalent consumption was significantly lower in the in the ketorolac group, 5 mg (IQR 0-14), compared to 15 mg (IQR 5-23) in the standard group (p < 0.001). There was no significant difference in transfusion rate between groups, respectively (3.5% vs. 1.6%, p [ 0.44). Based on findings from univariable analysis, on multivariable analysis, after adjusting for age, BMI, prior opioid use and length of stay, use of ketorolac remained independently associated with decreased narcotic use (b [ -5.1, 95% CI: -8.4 to -1.8, p [ 0.003) CONCLUSIONS: Scheduled ketorolac is effective in reducing peri-operative opioid utilization without increasing morbidity after robotic assisted simple prostatectomy.