Nissman Steven A, Tractenberg Rochelle E, Babbar-Goel Anita, Pasternak Joseph F
Soll Eye Associates, Philadelphia, Pennsylvania 19124, USA.
Am J Ophthalmol. 2008 Apr;145(4):623-629. doi: 10.1016/j.ajo.2007.11.012. Epub 2008 Jan 28.
To evaluate oral gabapentin for postoperative pain after photorefractive keratectomy (PRK).
Prospective, nonrandomized clinical trial.
In additional to a standard regimen of topical antibiotics, topical steroids, and topical tetracaine as required, all PRK patients at our laser vision center were treated after surgery for pain for a two-month period with Percocet (oxycodone/acetaminophen) [Endo Pharmaceuticals; Chadds Ford, Pennsylvania, USA] 5 mg/325 mg as required for three days (control group). Patients completed a pain assessment survey using a faces pain scale (from zero through 6) on the evening of surgery and each subsequent morning and evening until postoperative day 3. A successive cohort of patients received Neurontin (gabapentin) [Pfizer, New York, New York, USA] 300 mg thrice daily (first dose administered two hours or more before the procedure) as an oral pain medication for three days, and the same survey data were collected.
Data were collected on 141 patients in each cohort. Successful pain management score (defined as faces zero through 2 on the scale) differences did not reach statistical significance between the two cohorts except on the morning of the second postoperative day, when gabapentin was superior. On all postoperative days, patients in the oxycodone/acetaminophen cohort used significantly less tetracaine eye drops as required. The percent of patients rating overall pain experience as better than expected was 35% and 36%, those rating pain experience as about what was expected was 50% and 49%, and those rating pain experience as worse than expected was 15% and 15% in the oxycodone/acetaminophen and gabapentin cohorts, respectively.
We found no difference in overall subjective pain management ratings between gabapentin and oxycodone/acetaminophen for postoperative PRK pain, although gabapentin was associated with significantly more frequent use of anesthetic eye drops as required.
评估口服加巴喷丁用于准分子激光角膜切削术（PRK）术后疼痛的效果。
前瞻性、非随机临床试验。
除了根据需要使用局部抗生素、局部类固醇和局部丁卡因的标准方案外，我们激光视力中心的所有PRK患者术后均使用羟考酮/对乙酰氨基酚（美国宾夕法尼亚州查兹福德恩多制药公司）5毫克/325毫克，按需服用三天进行疼痛治疗（对照组）。患者在手术当晚以及术后第3天之前的每个早晚，使用面部疼痛量表（从0到6）完成疼痛评估调查。随后连续一组患者接受加巴喷丁（美国纽约辉瑞公司）每日三次，每次300毫克（首剂在手术前两小时或更长时间服用）作为口服止痛药，服用三天，并收集相同的调查数据。
每组收集了141例患者的数据。除术后第二天上午加巴喷丁组表现更优外，两组间成功的疼痛管理评分（定义为量表上的面部表情从0到2）差异未达到统计学意义。在所有术后日子里，羟考酮/对乙酰氨基酚组患者按需使用的丁卡因眼药水明显更少。羟考酮/对乙酰氨基酚组和加巴喷丁组中，将总体疼痛体验评为优于预期的患者比例分别为35%和36%，评为与预期差不多的患者比例分别为50%和49%，评为比预期差的患者比例分别为15%和15%。
我们发现加巴喷丁和羟考酮/对乙酰氨基酚在PRK术后疼痛的总体主观疼痛管理评分上没有差异，尽管加巴喷丁组按需使用麻醉眼药水的频率明显更高。
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