The treatment of pain following excimer laser photorefractive keratectomy: additive effect of local anesthetic drops, topical diclofenac, and bandage soft contact.
OBJECTIVE
Post-operative pain is a transient but undesirable side effect of photorefractive keratectomy (PRK). Pain control after excimer laser PRK was assessed in 112 eyes that were divided into 6 pain management groups.


METHODS
"Pain at its worst" was measured using a visual analog scale. The groups are arranged in order, Group 6 having experienced the most effective relief of pain and Group 1 the least relief of pain: 1) Topical amethocaine/tetracaine, 2) Topical amethocaine/tetracaine plus bandage contact lens, 3) Topical diclofenac, 4) Topical diclofenac plus bandage contact lens, 5) Topical amethocaine/tetracaine plus diclofenac, and 6) Topical amethocaine/tetracaine, diclofenac plus bandage contact lens. All patients were given 10 tablets of co-dydramol (10 mg dihydrocodeine and 500 mg paracetamol per tablet). They were to be used every 4 hours, but patients were specifically instructed not to take the tablets unless the topical pain management was inadequate for their needs.


CONCLUSIONS
Group 6 was dramatically better than any other group. In fact, 31% of Group 6 patients had no pain whatsoever. Removing any one of the 3 pain management tools resulted in much less pain control. Day 1 pain was also much more effectively controlled by the Group 6 management compared with those of the other groups. Group 6 patients took fewer co-dydramol tablets than any of the other groups. In addition, Group 6 scored best n several other areas that were studied: a) Day 1 light sensitivity; b) Day 1 tearing; c) Day 1 drowsiness; and d) number of hours slept on the first night. The epithelium healed in all patients but one Group 5 and one Group 6 patient had an epithelial defect for longer than 7 days. There was no instance of infectious keratitis, nor was there an instance of the sterile keratitis that has been associated with the use of topical non-steroidal anti-inflammatory drops.
Cherry
P M
PM
Corneal Laser Centre, St. James' University Hospital, Leeds, England.
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000221:Adaptation, Ocular / Q000187:drug effects; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D001458:Bandages; D003061:Codeine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D003261:Contact Lenses; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D054018:Lasers, Excimer; D009883:Ophthalmic Solutions; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy; D018903:Photorefractive Keratectomy / Q000009:adverse effects; D012890:Sleep / Q000187:drug effects; D012894:Sleep Stages / Q000187:drug effects; D013607:Tablets; D013666:Tears / Q000187:drug effects / Q000378:metabolism; D013748:Tetracaine / Q000008:administration & dosage / Q000627:therapeutic use; D014945:Wound Healing
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D013607:Tablets; D013748:Tetracaine; D004008:Diclofenac; D000082:Acetaminophen; C014481:dihydrocodeine; D003061:Codeine