Pacific Vision Institute, One Daniel Burnham Court, San Francisco, CA 94109, USA.
J Refract Surg. 2010 Dec;26(12):934-41. doi: 10.3928/1081597X-20100212-06. Epub 2010 Feb 15.
To investigate safety and efficacy of 0.5% morphine drops for pain control after photorefractive keratectomy (PRK).
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.
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.
Topical 0.5% morphine may be an effective and safe method of pain control after PRK.
研究 0.5%吗啡滴眼液用于准分子激光角膜切削术（PRK）后疼痛控制的安全性和疗效。
在一项双盲前瞻性研究中，将 40 例患者随机分为 0.5%吗啡滴眼液组（n=20）和载体对照组（n=20）。在 PRK 当天治疗后，每 2 小时滴眼一次，术后第 1 天至第 3 天每天滴眼 4 次。患者在治疗期间清醒时每 2 小时完成疼痛评估问卷（视觉描述符、数字评分、视觉模拟评分和口服镇痛药消耗量）。比较两组患者的日间平均和最大评分。术后第 4 天每天检查，术后第 4 周每周检查，术后第 3 个月每月检查。比较上皮愈合、角膜混浊和屈光结果。
在所有量表和 PRK 后 4 天的所有时间点，吗啡组的平均和最大疼痛评分均低于载体对照组。在数字评分量表上，在手术当天和术后第 1 天达到统计学意义（P<.05）。在手术当天、术后第 1 天和第 2 天，视觉模拟量表上两组之间的差异具有统计学意义。术后第 2 天，载体对照组的口服镇痛药消耗量更高。两组间在上皮愈合或屈光结果方面无差异。吗啡组的基质混浊评分较低，但差异无统计学意义。
局部应用 0.5%吗啡可能是 PRK 后控制疼痛的有效且安全的方法。
