title: A Non-Narcotic Pathway for the Management of Postoperative Pain Following Pediatric Robotic Pyeloplasty.
abstract: The purpose of this study is twofold: first, to describe the non-narcotic pathway (NNP) for the management of postoperative pain after robotic pyeloplasty (RP); second, to compare perioperative outcomes for children undergoing RP whose postoperative pain was managed with and without the NNP.
  
  
  
  A retrospective review was performed on 96 consecutive patients from October 2011 to December 2015 who underwent RP by three primary surgeons at a single pediatric institution. Children managed with an NNP received alternating doses of scheduled intravenous acetaminophen and ketorolac every 3 hours throughout the postoperative course. Perioperative outcomes were compared after grouping patients according to the type of postoperative pain management pathway. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using the two-tailed chi-squared test.
  
  
  
  A total of 49 (51.0%) patients were managed with the NNP, and 47 (49.0%) patients were managed without the NNP. A larger proportion of patients in the NNP did not receive postoperative narcotic medications (71.4% vs 25.5%; p < 0.001). Patients in the NNP were administered less narcotics (median 0.000 mg vs 0.041 mg morphine equivalents/kg/day; p < 0.001) and had a shorter length of stay (median 1.0 day vs 2.0 days; p < 0.001). There was no significant difference in the proportion of patients with postoperative complications (p = 0.958) or surgical success (p = 0.958).
  
  
  
  An NNP following pediatric RP is a viable and effective analgesic regimen that is associated with less narcotic use. It may also facilitate a shorter hospital stay. The majority of patients managed with this pathway had adequate pain control without being subject to the potential adverse effects of narcotic medications.
authors.affiliation: 1 Department of Urology, Temple University Hospital , Philadelphia, Pennslyvania.
authors.forename: Ziho
authors.initials: Z
authors.lastname: Lee
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Marion
authors.initials: M
authors.lastname: Schulte
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: W Robert
authors.initials: WR
authors.lastname: DeFoor
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Pramod P
authors.initials: PP
authors.lastname: Reddy
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Brian A
authors.initials: BA
authors.lastname: VanderBrink
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Minevich
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Liss
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Katherine
authors.initials: K
authors.lastname: Corbyons
authors.affiliation: 2 Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Noh
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D061605:Administration, Intravenous; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D020910:Ketorolac / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D020910:Ketorolac
keywords: analgesics; narcotics; non-narcotic; postoperative pain; robotics; ureteropelvic junction obstruction