Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs

Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs

Madeline Ripa,1 Brent Betts,1 Shagun Dhaliwal,1 Kaidi Wang,1 Severin Pouly,1 Danli Chen,2 Mark Mifflin1 1Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2Division of Epidemiology, University of Utah, Salt Lake City, UT, USACorre...

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Autores principales: Ripa M, Betts B, Dhaliwal S, Wang K, Pouly S, Chen D, Mifflin M
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2020
Materias:
pain
refractive surgery
photorefractive keratectomy
nonsteroidal anti-inflammatory drugs
naproxen
ketorolac
Ophthalmology
RE1-994
Acceso en línea:https://doaj.org/article/8b51ce502f1841ff959b409ca132c305
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spelling oai:doaj.org-article:8b51ce502f1841ff959b409ca132c3052021-12-02T09:11:51ZSurvey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs1177-5483https://doaj.org/article/8b51ce502f1841ff959b409ca132c3052020-05-01T00:00:00Zhttps://www.dovepress.com/survey-of-postoperative-pain-in-photorefractive-keratectomy-using-topi-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Madeline Ripa,1 Brent Betts,1 Shagun Dhaliwal,1 Kaidi Wang,1 Severin Pouly,1 Danli Chen,2 Mark Mifflin1 1Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2Division of Epidemiology, University of Utah, Salt Lake City, UT, USACorrespondence: Mark Mifflin Email mark.mifflin@hsc.utah.eduPurpose: To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral versus topical nonsteroidal anti-inflammatory drugs (NSAIDs).Patients and Methods: A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 157 subjects in a tertiary academic medical center setting. Patients were randomized to either topical ketorolac 0.4% every 12 hours or oral naproxen sodium 220 mg every 12 hours for 72 hours following PRK, beginning at the time of surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) for five days after surgery.Results: The peak pain scores were significantly higher in the oral NSAID group (mean 5.82, SD 1.94) compared to the topical NSAID group (mean 4.2, SD 2.19) (p< 0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly higher in the oral NSAID group (mean 5.17, SD 2.25) as compared to the topical NSAID group (mean 3.21, SD 2.09) (p< 0.0001). Pain scores 24– 72 hours after surgery (days 2 and 3) were higher than pain scores on days 1, 4, and 5 for both groups.Conclusion: Twice daily oral naproxen sodium 220 mg is inferior to twice daily topical ketorolac 0.4% in the treatment of early postoperative pain after PRK. This study also identified a consistent trend in which pain scores were highest 24– 72 hours after the procedure. This additional observation may be useful in understanding, preventing, and treating post-PRK pain.Keywords: pain, refractive surgery, photorefractive keratectomy, nonsteroidal anti-inflammatory drugs, naproxen, ketorolacRipa MBetts BDhaliwal SWang KPouly SChen DMifflin MDove Medical Pressarticlepainrefractive surgeryphotorefractive keratectomynonsteroidal anti-inflammatory drugsnaproxenketorolacOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 1459-1466 (2020)
institution DOAJ
collection DOAJ
language EN
topic pain
refractive surgery
photorefractive keratectomy
nonsteroidal anti-inflammatory drugs
naproxen
ketorolac
Ophthalmology
RE1-994
spellingShingle pain
refractive surgery
photorefractive keratectomy
nonsteroidal anti-inflammatory drugs
naproxen
ketorolac
Ophthalmology
RE1-994
Ripa M
Betts B
Dhaliwal S
Wang K
Pouly S
Chen D
Mifflin M
Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs
description Madeline Ripa,1 Brent Betts,1 Shagun Dhaliwal,1 Kaidi Wang,1 Severin Pouly,1 Danli Chen,2 Mark Mifflin1 1Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2Division of Epidemiology, University of Utah, Salt Lake City, UT, USACorrespondence: Mark Mifflin Email mark.mifflin@hsc.utah.eduPurpose: To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral versus topical nonsteroidal anti-inflammatory drugs (NSAIDs).Patients and Methods: A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 157 subjects in a tertiary academic medical center setting. Patients were randomized to either topical ketorolac 0.4% every 12 hours or oral naproxen sodium 220 mg every 12 hours for 72 hours following PRK, beginning at the time of surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) for five days after surgery.Results: The peak pain scores were significantly higher in the oral NSAID group (mean 5.82, SD 1.94) compared to the topical NSAID group (mean 4.2, SD 2.19) (p< 0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly higher in the oral NSAID group (mean 5.17, SD 2.25) as compared to the topical NSAID group (mean 3.21, SD 2.09) (p< 0.0001). Pain scores 24– 72 hours after surgery (days 2 and 3) were higher than pain scores on days 1, 4, and 5 for both groups.Conclusion: Twice daily oral naproxen sodium 220 mg is inferior to twice daily topical ketorolac 0.4% in the treatment of early postoperative pain after PRK. This study also identified a consistent trend in which pain scores were highest 24– 72 hours after the procedure. This additional observation may be useful in understanding, preventing, and treating post-PRK pain.Keywords: pain, refractive surgery, photorefractive keratectomy, nonsteroidal anti-inflammatory drugs, naproxen, ketorolac
format article
author Ripa M
Betts B
Dhaliwal S
Wang K
Pouly S
Chen D
Mifflin M
author_facet Ripa M
Betts B
Dhaliwal S
Wang K
Pouly S
Chen D
Mifflin M
author_sort Ripa M
title Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs
title_short Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs
title_full Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs
title_fullStr Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs
title_full_unstemmed Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs
title_sort survey of postoperative pain in photorefractive keratectomy using topical versus oral nonsteroidal anti-inflammatory drugs
publisher Dove Medical Press
publishDate 2020
url https://doaj.org/article/8b51ce502f1841ff959b409ca132c305
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