The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy

Abstract

Purpose: To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK).

Settings: Tel-Aviv Sourasky Medical Center-a tertiary medical center.

Design: Observational case-series.

Methods: Setting: Refractive center. Study Population: 205 PRK patients grouped randomly into five according to pain-management protocols: (1) paracetamol/ibuprofen (Parac-Ibupr group, n = 39), (2) high-dose oxycodone/naloxone only (Oxy-only group, n = 45), (3) oxycodone/naloxone and postoperative 0.1%-nepafenac (Oxy-Nep group, n = 36), (4) oxycodone/naloxone and preoperative and postoperative 0.1%-nepafenac (Nep-Oxy-Nep group, n = 42), and (5) preoperative and postoperative 0.1%-nepafenac only (Nep-only group, n = 43). Preoperative nepafenac was administered three times daily for 2 days. Main Outcome Measures: Mean and maximal pain levels (postop days 1-5), duration of tearing/photophobia, number of pain tablets taken, uncorrected visual acuity (UCVA), side effects and epithelial healing delay.

Results: Mean pain scores differed significantly between groups (p < 0.001)-lowest in groups receiving preop nepafenac (Nep-only: 1.8 ± 1.6, Nep-Oxy-Nep: 2.3 ± 1.5) compared to the Oxy-Nep (3.2 ± 1.9), Oxy-only (3.8 ± 1.7), and Parac-Ibupr (4.8 ± 1.6) groups. Similar findings were observed with maximal pain scores. Total number of pain tablets taken was lowest in the Nep-only group. Duration of photophobia was shortest in groups receiving preoperative nepafenac (p < 0.001). Duration of tearing was longest in the Parac-Ibupr group (p < 0.001). Nausea/vomiting occurred in 20% of the Oxy-only group (p < 0.001). There were four cases of delayed epithelial healing-all in groups not treated with nepafenac. One-month UCVA did not differ between groups. No additional independent factors were found to be associated with pain except age.

Conclusion: Adding preoperative nepafenac significantly reduced pain and photophobia with complete epithelial healing. Addition of oral opiates to nepafenac treatment had little analgetic benefit.

Keywords: NSAID; PRK; analgetic; nepafenac; nevanac; non-steroidal anti-inflammatory drug; pain; photorefractive keratectomy.

Figure 1.

VAS scores of each treatment group throughout postoperative days 1–5. VAS, Visual Analog Scale.

Figure 2.

Proportion of patients with tearing of each treatment group throughout postoperative days 1–5.

Figure 3.

Proportion of patients with photophobia of each treatment group throughout postoperative days 1–5.