Comparative Analysis Of Pain Management Strategies In Photorefractive Keratectomy Patients

The main objective of our study was to evaluate the efficacy of five different pharmacological regimens in managing postoperative pain in patients undergoing Photorefractive Keratectomy (PRK). Our secondary objective was to investigate the impact of these regimens on other adverse events, such as the duration of postoperative photophobia and tearing, and nausea/vomiting incidence.

Photorefractive Keratectomy (PRK) is a widely performed refractive procedure globally. Despite its efficacy, patients undergoing this procedure may experience several adverse events, including postoperative pain as a major concern, alongside photophobia, tearing, and nausea/vomiting. Numerous studies have explored different pharmacological approaches to address these postoperative adverse effects experienced by patients undergoing PRK surgery.

A prospective randomized trial was conducted to investigate the efficacy of five different pharmacological regimens in managing postoperative pain in patients undergoing Photorefractive Keratectomy (PRK). Patients who underwent the procedure were randomly assigned to one of five groups: Group 1 - Paracetamol/Ibuprofen; Group 2 - Oxycodone; Group 3 - Oxycodone/Nepafenac; Group 4 - Preoperative Nepafenac/Oxycodone; Group 5 -Preoperative Nepafenac. Following the surgery, patients were asked to complete questionnaires and provide information on their experience of postoperative VAS pain score, the duration of photophobia and tearing, nausea, and vomiting for five days.

A total of 205 patients completed the questionnaires; 39 patients in Group 1, 45 in Group 2, 36 in Group 3, 42 in Group 4, and 43 in Group 5. The patients had a mean age of 29.9±9.5 years, of whom 55.4% were women. Group 5 demonstrated the lowest VAS pain score, significantly lower than all other groups except Group 4, and Group 1 had the highest VAS pain score, significantly higher than all other groups except Group 2. A significant positive correlation was found between younger age and greater ablation depth to VAS pain score (p=0.001 and p=0.016, respectively). The shortest duration of photophobia and tearing was observed in Group 4. Nausea/vomiting was observed in Groups 2 and 3, 20% and 3%, respectively.

In patients who underwent PRK procedure, all five pharmacological regimens resulted in a decrease in VAS pain score during the first five days postoperatively. However, the Preoperative Nepafenac regimen was found to be the most effective in reducing postoperative pain, compared to the other four regimens examined in this study. Furthermore, a positive correlation between younger age and greater ablation depth to VAS pain scores was observed. Additionally, the Preoperative Nepafenac/Oxycodone regimen showed favorable outcomes with respect to the duration of postoperative photophobia and tearing.