Introduction: Post-ureteroscopy stent placement carries significant morbidity and pain which can interfere with daily life. This discomfort unfortunately leads many to opioid pain medications, which have a known risk of addiction. Cannabidiol (CBD) oil represents an alternative analgesic that has proven anti-inflammatory and antinociceptive effects. We sought to evaluate the effect of an FDA-approved CBD oil (Epidiolex) on pain control and opioid usage in the post-ureteroscopy setting.
Methods: This was a prospective, placebo-controlled, double-blind, randomized controlled trial at a tertiary care center. 90 patients undergoing ureteroscopy with stent placement for urinary stone disease were randomized 1:1 to placebo or 20 milligrams of CBD oil daily for 3 days post-operatively. Both groups were prescribed a rescue narcotic, tamsulosin, oxybutynin and phenazopyridine. Daily pain scores, medication usage and ureteral stent symptoms using the validated USSQ questionnaire were recorded for 3 days post-operatively.
Results: Both the placebo and CBD group were similar in pre- and peri-operative characteristics. We found no difference in average pain scores or opioid usage between groups post-operatively. Both groups endorsed similar discomfort with ureteral stents that affected their physical activity, sleep, urination, and daily life. Lastly, the majority of patients would have either mixed feeling or would be unhappy if they had to have a stent placed in the future.
Conclusions: CBD oil showed no difference compared to placebo in minimizing post-ureteroscopic stent discomfort or opioid usage. Despite the availability of numerous analgesic agents, patient experienced notable stent related symptoms and would be unhappy to have a stent placed in the future.
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