术前局部应用非甾体类抗炎药对准分子激光上皮下角膜磨镶术后疼痛的镇痛效果

Analgesic effect of preoperative topical nonsteroidal antiinflammatory drugs on postoperative pain after laser-assisted subepithelial keratectomy.

作者信息

Kim Se Kyung, Hong Jin Pyo, Nam Sang Min, Stulting Robert Doyle, Seo Kyoung Yul

机构信息

From the Nune Eye Hospital (Kim), the Saeyan Eye Clinic (Hong), and the Department of Ophthalmology (Seo), Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, and the Department of Ophthalmology (Nam), CHA Bundang Medical Center, CHA University, Seongnam, South Korea; the Stulting Research Center (Stulting), Woolfson Eye Institute, Atlanta, Georgia, USA.

出版信息

J Cataract Refract Surg. 2015 Apr;41(4):749-55. doi: 10.1016/j.jcrs.2014.06.041.

DOI:10.1016/j.jcrs.2014.06.041

PMID:25840299

Abstract

PURPOSE

To assess the effect of preoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) on postoperative pain after laser-assisted subepithelial keratectomy (LASEK) and to investigate their mechanism.

SETTING

Severance Eye Hospital and Saeyan Eye Clinic, Seoul, South Korea.

DESIGN

Prospective randomized clinical trial.

METHODS

Participants in 2 related studies were assessed. Study 1 comprised patients scheduled for bilateral LASEK (Group 1) who were randomized to receive an NSAID in 1 eye and a placebo in the fellow eye 30, 20, and 10 minutes before LASEK. Postoperative pain, glare, tearing, and irritation were assessed using a visual analog scale. Study 2 comprised healthy subjects (Group 2) who were randomly divided into subgroups. The participants in these subgroups were randomized to receive ketorolac tromethamine 0.5% in 1 eye and placebo (ofloxacin 0.3%) in the fellow eye (Group 2A), proparacaine hydrochloride 0.5% in 1 eye and placebo in the fellow eye (Group 2B), or ketorolac tromethamine 0.5% in 1 eye and placebo in the fellow eye, followed 10 minutes later by 1 drop of proparacaine hydrochloride 0.5% in both eyes (Group 2C). In all 3 groups, corneal sensitivity was measured after 1, 2, and 6 hours.

RESULTS

The mean postoperative pain score in the NSAID-pretreated eye was statistically significantly lower than in the placebo-pretreated eye 6, 12, and 24 hours postoperatively (P < .05). The mean corneal sensitivity was statistically significantly lower in the NSAID-treated eye than in the placebo-treated eye at 1 and 2 hours in Groups 2A and 2C (P < .05).

CONCLUSION

Preoperative administration of topical NSAIDs before LASEK effectively reduces postoperative pain.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

摘要

目的

评估术前局部使用非甾体类抗炎药（NSAIDs）对准分子激光上皮下角膜磨镶术（LASEK）术后疼痛的影响，并探讨其作用机制。

设置

韩国首尔Severance眼科医院和Saeyan眼科诊所。

设计

前瞻性随机临床试验。

方法

对2项相关研究的参与者进行评估。研究1纳入计划行双眼LASEK的患者（第1组），随机分为在LASEK术前30、20和10分钟，一只眼使用NSAIDs，另一只眼使用安慰剂。使用视觉模拟量表评估术后疼痛、眩光、流泪和刺激症状。研究2纳入健康受试者（第2组），随机分为亚组。这些亚组的参与者被随机分为一只眼使用0.5%酮咯酸氨丁三醇，另一只眼使用安慰剂（0.3%氧氟沙星）（第2A组），一只眼使用0.5%盐酸丙美卡因，另一只眼使用安慰剂（第2B组），或一只眼使用0.5%酮咯酸氨丁三醇，另一只眼使用安慰剂，10分钟后双眼各滴入1滴0.5%盐酸丙美卡因（第2C组）。在所有3组中，分别于1、2和6小时后测量角膜敏感性。