Routinely prescribing narcotics to men undergoing vasectomy appears unnecessary and associated with long-term use, according to new study findings published in the Journal of Urology.
David W. Barham, MD, and colleagues from Tripler Army Medical Center in Honolulu, reviewed the medical charts of 228 patients from the urology clinic who underwent vasectomy during 2017 to 2018. At the time of the procedure, 102 patients received opioid prescriptions (for 5 to 20 pills) and 126 did not. Of the 8 urologists, 2 routinely prescribed opioids for post-vasectomy pain and 6 relied entirely on alternative pain control strategies, such as over-the-counter acetaminophen and ibuprofen, scrotal support, and ice.
The investigators found no significant difference in medical encounters for scrotal pain between patients: 12.7% of opioid users vs 18.4% of nonusers contacted a health care provider about pain within 30 days of their vasectomy. Men who received an initial opioid prescription were less likely to receive a second one: 1.9% vs 9.5%, respectively. Nonetheless, significantly more men who received opioids after vasectomy reported persistent opioid use at 3 to 6 months: 7.8% vs 1.5%, respectively.
According to the researchers, the new study results align with previously published data demonstrating short-term opioid prescription for postoperative pain leads to persistent use at 90 days in 6% to 10% of patients. The team also cited several studies finding overprescription of opioids after urological surgery according to leftover pill counts.
“No amount of opioids has been found safe or free from addiction risk,” according to Dr Barham’s team. The 2018 American Urological Association Position Statement on opioid use recommends using opioids only when necessary and at the lowest dose possible for the shortest duration.
“Our study demonstrates that routine prescription of opioids after vasectomy would save approximately 6% of post-vasectomy encounters for scrotal pain but would lead to new persistent use in 7.8% of patients. This is an unacceptable trade-off. We hope that this finding will encourage urologists to use greater discretion when prescribing opioids.”
In an accompanying editorial, Martin S. Gross, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, agreed:
“These results should reduce knee-jerk opioid prescriptions for post-vasectomy pain, which generally seems to respond well to nonsteroidal anti-inflammatories and multimodal analgesia.”
Barham DW, McMann LP, Musser JE, et al. Routine prescription of opioids for post-vasectomy pain control associated with persistent use. J Urol. 2019;202:806-810. doi:10.1097/JU.0000000000000304
Gross MS. Editorial Comment. J Urol. 2019;202:810