The Combination of Ketorolac with Local Anesthesia for Pain Control in Day Care Retinal Detachment Surgery: A Randomized Controlled Trial

Abstract

This study aims to evaluate the efficacy of ketorolac with local anesthesia compared to local anesthesia alone for perioperative pain control in day care retinal detachment surgery. The randomized controlled trial included 59 eyes of 59 participants for retinal detachment surgery who were randomly assigned (1 : 1) into the ketorolac (K) group and control (C) group. All participants underwent conventional local anesthesia while patients in the K group received an extra administration of preoperative ketorolac. Participants in the K group had a statistically significantly lower intraoperative NRS score (median 1.0 versus 3.0, P = 0.003), lower postoperative NRS score (median 0 versus 1.0, P = 0.035), fewer proportion of rescue analgesic requirement (10% versus 34.5%, P = 0.023), and lower incidence of postoperative nausea and vomiting (13.3% versus 41.4%, P = 0.015) compared to the C group. Intraocular pressure (IOP) changes (△IOP) were significantly reduced in the K group (median 1.9 versus 3.0, P = 0.038) compared to the C group 24 hours postoperatively. In conclusion, the combination of local anesthesia with ketorolac provides better pain control in retinal detachment surgery compared to local anesthesia alone. The beneficial effect of ketorolac with local anesthesia may contribute to a wider-spread adoption of day care retinal detachment surgery. This trial is registered with ClinicalTrials.gov NCT02729285.

Figure 1

A flow chart showing the enrollment, assignment, procedures, outcome assessments, and data analysis during the whole study. RRD = rhegmatogenous retinal detachment; SB = scleral buckling; LA = local anesthesia; BCVA = best-corrected visual acuity; IOP = intraocular pressure; NRS = Numerical Rating Scales.

Figure 2

Number of participants with different levels of pain feelings in the K and C groups during the operation. Pain levels were defined by NRS scores: no = 0; mild = 1–3; moderate = 4–6; severe = 7–10.

Figure 3

A comparison of NRS scores between the K and C groups both intraoperatively and postoperatively. Intra-K = intraoperative assessment in the ketorolac group; intra-C = intraoperative assessment in the control group; post-K = postoperative assessment in the ketorolac group; post-C = postoperative assessment in the control group.