Effect of topical 0.5% morphine on postoperative pain after photorefractive keratectomy.
OBJECTIVE
To investigate safety and efficacy of 0.5% morphine drops for pain control after photorefractive keratectomy (PRK).


METHODS
In a double-blind prospective study, 40 patients were randomized to either 0.5% morphine drops (n=20) or vehicle control (n=20). Treatment occurred every 2 hours following PRK on the day of the procedure, then four times daily on postoperative days 1 through 3. Patients completed pain assessment questionnaires (visual descriptor, numerical rating, visual analog scales, and oral analgesic consumption) every 2 hours while awake during the treatment period. Daily average and maximum scores were compared between the two groups. Patients were examined daily for 4 days after PRK, weekly for 4 weeks, then monthly for 3 months. Epithelial healing, corneal haze, and refractive outcomes were compared.


RESULTS
Both average and maximum pain scores were lower in the morphine group than in the vehicle control group on all scales and during all 4 days after PRK. Statistical significance (P<.05) was reached on numeric rating scale on procedure day and on postoperative day 1. The difference between the groups on the visual analog scale was statistically significant on procedure day, and on postoperative days 1 and 2. Oral analgesic consumption was higher in the vehicle control group on postoperative day 2. No difference between groups was noted in epithelial healing or refractive outcomes. Stromal haze scores were lower in the morphine group, but the difference was not statistically significant.


CONCLUSIONS
Topical 0.5% morphine may be an effective and safe method of pain control after PRK.
Faktorovich
Ella G
EG
Pacific Vision Institute, One Daniel Burnham Court, San Francisco, CA 94109, USA. ella@pacificvision.org
Basbaum
Allan I
AI
D000287:Administration, Topical; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D018903:Photorefractive Keratectomy; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D000701:Analgesics, Opioid; D009883:Ophthalmic Solutions; D009020:Morphine