From the Department of Ophthalmology, New York University, New York, New York (Donnenfeld); the Ophthalmic Consultants of Long Island, New York (Donnenfeld, D. Mychajlyszyn, A. Mychajlyszyn, Stein).
J Cataract Refract Surg. 2022 Jul 1;48(7):759-764. doi: 10.1097/j.jcrs.0000000000000855. Epub 2021 Oct 29.
To compare pain and the need for the opioid fentanyl use associated with the administration of phenylephrine 1.0%-ketorolac 0.3% (P/K) with those of epinephrine administration during cataract surgery.
Ambulatory surgery center.
Single-center, prospective, randomized, double-masked, self-controlled trial.
Patients undergoing bilateral, topical anesthetic cataract surgery were randomized to receive either intracameral P/K or epinephrine in their balanced salt solution for the first eye and the other for the second eye, 2 weeks later. Fentanyl was used to manage intraoperative pain. The primary end point was the need for fentanyl administration intraoperatively. Secondary outcomes included pain measurements; surgery duration; effective phacoemulsification time; pupil size; and complications.
112 eyes of 56 patients were enrolled. Significantly fewer eyes in the P/K group (7 [12.5%]) than in the epinephrine group (19 [33.9%]; P = .013) required intraoperative fentanyl administration. Mean pain scores were lower in the P/K group than those in the control group at all timepoints. For patients with no pain to mild pain (pain scores ≤ 3), 85.7% (n = 48) of the P/K group and 58.9% (n = 33) of the epinephrine group met this benchmark ( P = .003) intraoperatively. The combined outcome, the number of patients not receiving intravenous fentanyl and experiencing no pain to mild pain, was significantly higher in the study (82.1%, n = 46) than in the control group (58.9%, n = 33; P = .013).
P/K administration significantly reduced pain and the need for fentanyl use. Using P/K is a practical way for cataract surgeons to provide better patient care and reduce the need for intraoperative opioids.
比较在白内障手术中应用苯肾上腺素 1.0%-酮咯酸 0.3%（P/K）与应用肾上腺素时的疼痛程度和阿片类药物芬太尼的使用需求。
门诊手术中心。
单中心、前瞻性、随机、双盲、自身对照试验。
接受局部麻醉白内障手术的患者被随机分为两组，第一只眼接受房水中的 P/K 或肾上腺素加平衡盐溶液，第二只眼 2 周后接受另一种药物，术中均使用芬太尼管理疼痛。主要终点是术中需要使用芬太尼的情况。次要结局包括疼痛测量、手术时间、有效超声乳化时间、瞳孔大小和并发症。
纳入了 56 例患者的 112 只眼。与肾上腺素组（19 只眼[33.9%]）相比，P/K 组（7 只眼[12.5%]）术中需要芬太尼的眼明显较少（P=0.013）。在所有时间点，P/K 组的平均疼痛评分均低于对照组。对于无疼痛至轻度疼痛（疼痛评分≤3）的患者，P/K 组有 85.7%（n=48），肾上腺素组有 58.9%（n=33）符合该标准（P=0.003）。在研究中，未接受静脉芬太尼且无疼痛至轻度疼痛的患者数量明显高于对照组（82.1%，n=46），而对照组为 58.9%（n=33；P=0.013）。
P/K 给药可显著减轻疼痛和芬太尼的使用需求。对于白内障外科医生来说，使用 P/K 是提供更好的患者护理和减少术中阿片类药物需求的一种实用方法。
