Narcotic-Free Percutaneous Nephrolithotomy

This is a randomized control trial comparing oral ketorolac (10mg, Q6 PRN) and oxycodone (5mg, Q6 PRN) medication for the use of post-operative analgesia after kidney stone removal surgery called percutaneous nephrolithotomy (PCNL). Primary endpoints are visual analog pain scores (VAS) for days 1-5 and day 10 post operatively. Secondary endpoints are pill counts, patient-related outcome survey (PROMIS) scores, emergency room visits, and patient telephone calls. 90 subjects will be enrolled, with 45 in each group.

Inclusion criteria

• Undergoing scheduled unilateral standard (24Fr), PCNL with at least 2cm stone burden, with expected single access

Exclusion criteria

• Pregnant women
• History of chronic opioid abuse
• Allergy, hypersensitivity, or other contraindication to NSAID usage such as

• eGFR < 60 mL/min
• Peptic ulcer disease or history of gastric bypass
• Concurrent use of antiplatelet or anticoagulation therapy (including aspirin)
• Thrombocytopenia
• Suspected or confirmed cerebrovascular bleeding, patients with hemorrhagic diathesis, incomplete hemostasis, and those at high risk of bleeding.
• Concomitant medications:

• Other NSAIDs
• Antiplatelet or anticoagulation medications
• Probenecid
• Pentoxifylline
• Allergy, hypersensitivity, or other contraindication to opioids:

• Current opioid prescription/usage for any reason, including active treatment with suboxone or methadone
• Respiratory depression
• Patients with acute or severe bronchial asthma or hypercarbia
• Patients who have or is suspected of having paralytic ileus as PCNL done under general anesthesia
• Patients with hepatic Impairment
• Concomitant medications:

• Monoamine Oxidase Inhibitors (MAOIs)
• Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics
• Diagnosis of chronic pain disorder
• Reduced sensation of abdomen or pelvis (e.g. patients with spinal cord injury)
• Pre-existing stent or nephrostomy tube
• Urinary tract anomalies such as urinary diversion, horseshoe kidney, solitary kidney, urinary stricture disease, ureteropelvic junction obstruction, pelvic kidney, stone in calyceal diverticulum)
• Pulmonary disease
• Liver disease
• Seizure disorders
• Subjects taking nephrotoxic medications
• Subjects taking medications that can increase sedation risk (benzodiazepines or other sedative hypnotics)