@Article{,
AUTHOR = {Nazih Khater, Mohamed Keheila, Michelle Lightfoot, Jim Shen, Samuel Abourbih, Muhannad Alsyouf, Roger Li, D. Duane Baldwin},
TITLE = {Predictors of narcotic use after percutaneous nephrolithotomy},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {24},
YEAR = {2017},
NUMBER = {1},
PAGES = {8634--8640},
URL = {http://www.techscience.com/CJU/v24n1/61080},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction: </b>Percutaneous nephrolithotomy (PCNL) 
is associated with significant variability in postoperative 
pain and subsequent narcotic use. The purpose of this 
study was to determine the factors associated with high 
narcotic use following PCNL.<br/>
<b>Materials and methods:</b> A single-center retrospective 
review of patients undergoing initial PCNL between 2004 
and 2014 was performed. Preoperative, intraoperative and 
postoperative factors associated with postoperative narcotic 
usage were analyzed. The primary outcome variable 
was mean narcotic usage, standardized to intravenous 
morphine-equivalents. Patients in the lowest 75th percentile 
were compared to those in the highest 25th percentile. 
Univariate and multivariate statistical analyses were 
performed, with p < 0.05 considered significant.<br/>
<b>Results:</b> When the 243 patients were compared from 
lowest to highest quartile, total narcotic use during the 
first 48 hour period was 2.3, 8.4, 15.6, and 41.7 mg of 
morphine-equivalents. On univariate analysis, predictors 
of high narcotic use included age 20-39 (p < 0.001), 
preoperative narcotic use (p < 0.001), presence of a 
postoperative complication (p = 0.044), and high stone 
burden (p = 0.002). Age < 20 (p < 0.001) and > 60 years 
(p = 0.014) were associated with low narcotic use. On 
multivariate analysis, age 20-39 (OR 6.87, 95% CI 2.22-
21.23, p = 0.001), male gender (OR 2.47, CI 1.05-5.81, 
p = 0.037), and preoperative narcotic use (OR 3.27, CI 
1.41-7.60, p = 0.006) were associated with higher opioid 
requirement. <br/>
<b>Conclusion: </b>Patients who were aged 20-39, males, 
and those with prior narcotic exposure used the highest 
doses of narcotics postoperatively. Knowledge of the 
factors predictive of high narcotic usage may allow 
better preoperative management of patient expectations 
and more effective postoperative care to prevent the 
complications of high narcotic usage.},
DOI = {}
}