Preoperative oxybutynin lowers opioid use after paediatric urologic surgery

A single dose of oxybutynin before urologic surgery helps children with an indwelling urinary drain to reduce their use of opioid after the procedure, a study has shown.

“Urologic surgery involving placement of an indwelling ureteral and/or urethral drain can be associated with significant catheter-related bladder discomfort causing increased postoperative morbidity and opioid medication use,” the researchers said.

In this retrospective study at a single institution, researchers identified paediatric patients who had surgery on the urinary tract with concomitant placement of a urethral or ureteral drain. Patients received a single weight-based dose of oral oxybutynin in the preoperative area prior to the procedure.

Receipt of postoperative opioid medication was the primary outcome. Variables associated with postoperative use of opioids were assessed using multivariable regression analyses.

Of the 134 patients included in the final analysis, 42 received oxybutynin and 92 did not. No statistical difference was seen in age, procedure type, anaesthesia block, postoperative drain, or intraoperative morphine milligram equivalents per kilogram between groups.

Patients who received preoperative oxybutynin showed a reduced utilization of opioids postoperatively relative to those who did not receive oxybutynin (19 percent vs 47 percent).

Multivariable logistic regression analysis revealed that preoperative oxybutynin was associated with a 77-percent lower likelihood of receiving postoperative opioid (odds ratio, 0.23, 95 percent confidence interval, 0.09–0.56; p<0.001).

“For paediatric patients with an indwelling urinary drain after urologic surgery, a single preoperative dose of oxybutynin was significantly associated with lower postoperative utilization of opioids,” the researchers said. “This relatively low-risk intervention can be easily implemented.”