Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial.
OBJECTIVE
To evaluate the efficacy of pain relief by oral diazepam, acetaminophen, mefenamic acid, intramuscular ketorolac tromethamine, and peribulbar anaesthesia in panretinal photocoagulation (PRP).


METHODS
A total of 220 patients with proliferative diabetic retinopathy requiring PRP treatment were enrolled in this study. Before laser treatment, the patients were allocated randomly to one of eight groups: group 1: diazepam (n=22), group 2: acetaminophen (n=21), group 3: mefenamic acid (n=21), group 4: diazepam and acetaminophen (n=22), group 5: diazepam and mefenamic acid (n=22), group 6: peribulbar anaesthesia with lidocaine (n=23), group 7: intramuscular injection of ketorolac tromethamine (n=22), group 8: placebo (n=67). Pain after the laser treatment was assessed by a verbal descriptive scale. Blood pressure and heart rate were measured before and after laser treatment.


RESULTS
Patients receiving peribulbar anaesthesia had a significantly lower pain score than the control group (P<0.0001). Additionally, the peribulbar anaesthesia-treated group had the significantly least PRP-associated rise in either systolic (P=0.043) or diastolic blood pressure rates (P=0.030). There were no significant differences in pain score using other anesthetic agents when compared with the control group. There were no significant changes in heart rate after PRP treatment.


CONCLUSIONS
Peribulbar anaesthesia is effective in reducing pain and blood pressure increase after PRP treatment. Oral diazepam, mefenamic acid, and acetaminophen (either alone or in combination with each other) are not effective in preventing PRP treatment-associated pain. Intramuscular injection of ketorolac tromethamine is also not effective in reducing PRP-associated pain.
Wu
W-C
WC
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Hsu
K-H
KH
Chen
T-L
TL
Hwang
Y-S
YS
Lin
K-K
KK
Li
L-M
LM
Shih
C-P
CP
Lai
C-C
CC
D000082:Acetaminophen; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001794:Blood Pressure; D003930:Diabetic Retinopathy / Q000601:surgery*; D003975:Diazepam; D005260:Female; D006339:Heart Rate; D006801:Humans; D020911:Ketorolac Tromethamine; D017075:Laser Coagulation / Q000009:adverse effects*; D008012:Lidocaine; D008297:Male; D008528:Mefenamic Acid; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D008528:Mefenamic Acid; D020911:Ketorolac Tromethamine; D008012:Lidocaine; D003975:Diazepam