Arkansas Children’s Urology is committed to reducing narcotic prescriptions following certain urological surgeries.
The first use of the narcotics reduction quality improvement project kicked off in the fall of 2023, using a longerlasting regional anesthetic injection, a pudendal block, for all circumcisions.
“We noticed a lot of our patients were not requiring narcotics at home after using the pudendal block. After the second day at home, most of these pediatric patients were back to baseline without any additional narcotics,” said Ashay Patel, D.O., a pediatric urologist and chief of urology at Arkansas Children’s and associate professor of urology at the University of Arkansas for Medical Sciences. “There’s a focus nationwide to reduce narcotics use, and our current quality improvement project extends this concept to other urological surgeries. We’re reducing narcotics for patients who have outpatient orchiopexy, a surgery to fix undescended testicles.”
For orchiopexy, the team uses a caudal block in the operating room for children under 5 years old. Older patients receive local medicine to the surgical area. In fiscal year (FY) 2025, providers at Arkansas Children’s Hospital in Little Rock performed orchiopexy on 144 patients. Providers at Arkansas Children's Northwest in Springdale performed the procedure on 73 patients.
Dr. Patel said they’ve reduced narcotics prescriptions substantially. The percentage of pediatric patients prescribed narcotics for orchiopexy by fiscal year was:
So far in FY2026, Dr. Patel said the percentage has dropped to 11.5% as of September 2025.
“It’s good for the state. You may only give two or three doses of a narcotic, and a patient may not use it. Then, the medication is sitting at the house, and anyone in the house has access to these drugs. It’s the same pain medication an adult would take, just at a lower dose,” Dr. Patel said. “We’re doing our part to help the state reduce narcotics abuse and prevent the downstream effects. Our urology team is willing to take on this project because we believe most children do well with non-opioid pain medications, alternating acetaminophen and ibuprofen, after surgery. Most parents tell us by the following day that their children were acting normal again.”
Urology still prescribes narcotics for some inpatient abdominal surgeries. Following a nationwide trend, the team is looking to reduce narcotics for hypospadias surgeries next.
Urology providers and nurses lead this quality improvement project, and the team collaborates with anesthesiologists for nerve blockers.
Dr. Patel said this effort is a testament to training and willingness to listen to patients and families.
“A driving force for these projects is being willing to change our practice patterns so it’s better for the patient,” he said.
