title: Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study.
abstract: OBJECTIVE
  To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort.
  
  
  METHODS
  A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intraoperatively, in the recovery unit, and at home was recorded.
  
  
  RESULTS
  Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and "high-pain" measure (P = .02) CONCLUSION: B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Franklin C
authors.initials: FC
authors.lastname: Lee
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Hsi
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Haynes
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: jdharper@uw.edu.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Harper
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001532:Atropa belladonna; D001285:Atropine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009892:Opium / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D010276:Parasympatholytics / Q000008:administration & dosage; D008517:Phytotherapy; D010936:Plant Extracts / Q000008:administration & dosage; D011300:Preoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D012601:Scopolamine / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects*; D013488:Suppositories; D018666:Ureteroscopy / Q000009:adverse effects*; D014545:Urinary Calculi / Q000601:surgery
chemical_list: D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D010276:Parasympatholytics; D010936:Plant Extracts; D013488:Suppositories; D001285:Atropine; D009892:Opium; D012601:Scopolamine