Patients recovering from percutaneous nephrolithotomy (PCNL) may experience multiple sources of pain. To encourage opioid stewardship, patients’ in-hospital opioid use may help determine post-discharge prescribing needs. We aimed to characterize patient-reported pain outcomes based on a PCNL opioid prescribing algorithm.

A prospective cohort of adult patients undergoing standard (24–30 Fr) PCNL were enrolled. Patients were discharged with ureteral stents for 1 week. Patients received multimodal analgesics, including acetaminophen, NSAIDs, tamulosin, and anticholinergics. We followed an evidence-based opioid prescribing algorithm based on inpatient opioid use in the 24 hours prior to discharge: patients who used 0 morphine milligram equivalents (MME) were prescribed no opioids; patients who used ≤25 MME were prescribed up to 37.5 MME (5 tablets oxycodone 5 mg); and patients who used >25 MME were prescribed up to 75 MME (10 tablets oxycodone 5 mg). Patients reported pain scores, opioid use, and symptoms on day 3, 7, and 14 after discharge. Patients were surveyed at 4 weeks about total medication use and opioid disposition.

A total of 75 patients were enrolled. Most patients reported mild pain during post-discharge recovery that resolved within 1 week: median pain scores were 3 (IQR 1–4) at day 3, 1 (IQR 0–2) at day 7, and 0 (IQR 0–2) at day 14 (Figure). The most bothersome symptom during recovery was bladder spasm (31%), flank pain (28%), and incision pain (15%). Using the algorithm, 32% of patients were prescribed opioids at discharge. Among the opioid group, 83% reported taking at least 1 dose. There were no significant differences in pain scores based on whether opioids were prescribed. No patients required a new or refill opioid prescription after discharge. At 4 weeks after surgery, 78% of patients who were prescribed opioids still had unused opioids, with a median of 50% of the total prescribed MME remaining (IQR 40–60%). Only 6% of patients had disposed of unused opioids.

In a prospective cohort study of PCNL patients, 100% of patients who used no or minimal opioids during hospitalization were safely discharged without opioids. Patients who were prescribed opioids at discharge typically used only half of the total MME, supporting further dose reductions in opioid prescribing recommendations after PCNL.