Levinger Eliya, Gomel Nir, Hirsh Ami, Tenne Maya, Achiron Asaf, Levinger Nadav, Levinger Shmuel, Shemesh Nadav, Abulafia Adi, Mimouni Michael, Sorkin Nir
Department of Ophthalmology, Tel-Aviv Medical Center, Weizzman 6, Tel Aviv 6423906 Israel Enaim Medical Center, Tel-Aviv, Israel.
Department of Ophthalmology, Tel-Aviv Medical Center, Weizzman 6, Tel Aviv 6423906 Israel.
Ther Adv Ophthalmol. 2025 Jun 24;17:25158414251349340. doi: 10.1177/25158414251349340. eCollection 2025 Jan-Dec.
To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK).
Tel-Aviv Sourasky Medical Center-a tertiary medical center.
Observational case-series.
: Refractive center. : 205 PRK patients grouped randomly into five according to pain-management protocols: (1) paracetamol/ibuprofen (Parac-Ibupr group, = 39), (2) high-dose oxycodone/naloxone only (Oxy-only group, = 45), (3) oxycodone/naloxone and postoperative 0.1%-nepafenac (Oxy-Nep group, = 36), (4) oxycodone/naloxone and preoperative and postoperative 0.1%-nepafenac (Nep-Oxy-Nep group, = 42), and (5) preoperative and postoperative 0.1%-nepafenac only (Nep-only group, = 43). Preoperative nepafenac was administered three times daily for 2 days. : Mean and maximal pain levels (postop days 1-5), duration of tearing/photophobia, number of pain tablets taken, uncorrected visual acuity (UCVA), side effects and epithelial healing delay.
Mean pain scores differed significantly between groups ( < 0.001)-lowest in groups receiving preop nepafenac (Nep-only: 1.8 ± 1.6, Nep-Oxy-Nep: 2.3 ± 1.5) compared to the Oxy-Nep (3.2 ± 1.9), Oxy-only (3.8 ± 1.7), and Parac-Ibupr (4.8 ± 1.6) groups. Similar findings were observed with maximal pain scores. Total number of pain tablets taken was lowest in the Nep-only group. Duration of photophobia was shortest in groups receiving preoperative nepafenac ( < 0.001). Duration of tearing was longest in the Parac-Ibupr group ( < 0.001). Nausea/vomiting occurred in 20% of the Oxy-only group ( < 0.001). There were four cases of delayed epithelial healing-all in groups not treated with nepafenac. One-month UCVA did not differ between groups. No additional independent factors were found to be associated with pain except age.
Adding preoperative nepafenac significantly reduced pain and photophobia with complete epithelial healing. Addition of oral opiates to nepafenac treatment had little analgetic benefit.
评估术前使用奈帕芬酸对酒精辅助准分子激光原位角膜磨镶术（PRK）后疼痛的影响。
特拉维夫索拉斯基医疗中心——一家三级医疗中心。
观察性病例系列。
屈光中心。205例PRK患者根据疼痛管理方案随机分为五组：（1）对乙酰氨基酚/布洛芬组（对乙酰氨基酚-布洛芬组，n = 39），（2）仅使用高剂量羟考酮/纳洛酮组（仅羟考酮组，n = 45），（3）羟考酮/纳洛酮和术后0.1%奈帕芬酸组（羟考酮-奈帕芬酸组，n = 36），（4）羟考酮/纳洛酮以及术前和术后使用0.1%奈帕芬酸组（奈帕芬酸-羟考酮-奈帕芬酸组，n = 42），（5）仅术前和术后使用0.1%奈帕芬酸组（仅奈帕芬酸组，n = 43）。术前奈帕芬酸每日给药3次，共2天。观察指标包括：平均和最大疼痛水平（术后1 - 5天）、流泪/畏光持续时间、服用的止痛片数量、未矫正视力（UCVA）、副作用以及上皮愈合延迟情况。
各组间平均疼痛评分差异显著（P < 0.001）——与羟考酮-奈帕芬酸组（3.2±1.9）、仅羟考酮组（3.8±1.7）和对乙酰氨基酚-布洛芬组（4.8±1.6）相比，接受术前奈帕芬酸治疗的组（仅奈帕芬酸组：1.8±1.6，奈帕芬酸-羟考酮-奈帕芬酸组：2.3±1.5）疼痛评分最低。最大疼痛评分也有类似发现。仅奈帕芬酸组服用的止痛片总数最少。接受术前奈帕芬酸治疗的组畏光持续时间最短（P < 0.001）。对乙酰氨基酚-布洛芬组流泪持续时间最长（P < 0.001）。仅羟考酮组20%的患者出现恶心/呕吐（P < 0.001）。有4例上皮愈合延迟——均在未使用奈帕芬酸治疗的组中。各组间1个月时的UCVA无差异。除年龄外，未发现其他与疼痛相关的独立因素。
术前添加奈帕芬酸可显著减轻疼痛和畏光症状，并实现上皮完全愈合。在奈帕芬酸治疗中添加口服阿片类药物镇痛效果甚微。
