Cherry P M
Corneal Laser Centre, St. James' University Hospital, Leeds, England.
Ophthalmic Surg Lasers. 1996 May;27(5 Suppl):S477-80.
Post-operative pain is a transient but undesirable side effect of photorefractive keratectomy (PRK). Pain control after excimer laser PRK was assessed in 112 eyes that were divided into 6 pain management groups.
"Pain at its worst" was measured using a visual analog scale. The groups are arranged in order, Group 6 having experienced the most effective relief of pain and Group 1 the least relief of pain: 1) Topical amethocaine/tetracaine, 2) Topical amethocaine/tetracaine plus bandage contact lens, 3) Topical diclofenac, 4) Topical diclofenac plus bandage contact lens, 5) Topical amethocaine/tetracaine plus diclofenac, and 6) Topical amethocaine/tetracaine, diclofenac plus bandage contact lens. All patients were given 10 tablets of co-dydramol (10 mg dihydrocodeine and 500 mg paracetamol per tablet). They were to be used every 4 hours, but patients were specifically instructed not to take the tablets unless the topical pain management was inadequate for their needs.
Group 6 was dramatically better than any other group. In fact, 31% of Group 6 patients had no pain whatsoever. Removing any one of the 3 pain management tools resulted in much less pain control. Day 1 pain was also much more effectively controlled by the Group 6 management compared with those of the other groups. Group 6 patients took fewer co-dydramol tablets than any of the other groups. In addition, Group 6 scored best n several other areas that were studied: a) Day 1 light sensitivity; b) Day 1 tearing; c) Day 1 drowsiness; and d) number of hours slept on the first night. The epithelium healed in all patients but one Group 5 and one Group 6 patient had an epithelial defect for longer than 7 days. There was no instance of infectious keratitis, nor was there an instance of the sterile keratitis that has been associated with the use of topical non-steroidal anti-inflammatory drops.
术后疼痛是准分子激光角膜切削术（PRK）的一种短暂但令人不适的副作用。对112只眼睛进行了评估，这些眼睛被分为6个疼痛管理组，以研究准分子激光PRK术后的疼痛控制情况。
使用视觉模拟量表测量“最严重疼痛程度”。各分组按疼痛缓解效果从高到低依次排列：第6组疼痛缓解最有效，第1组疼痛缓解效果最差。分组如下：1）局部使用丁卡因/丁哌卡因；2）局部使用丁卡因/丁哌卡因并佩戴绷带式隐形眼镜；3）局部使用双氯芬酸；4）局部使用双氯芬酸并佩戴绷带式隐形眼镜；5）局部使用丁卡因/丁哌卡因加双氯芬酸；6）局部使用丁卡因/丁哌卡因、双氯芬酸并佩戴绷带式隐形眼镜。所有患者均服用10片可待因（每片含10毫克二氢可待因和500毫克对乙酰氨基酚）。每4小时服用一次，但特别指示患者，除非局部疼痛管理无法满足其需求，否则不得服用该片剂。
第6组明显优于其他任何组。事实上，第6组中有31%的患者完全没有疼痛。去除三种疼痛管理工具中的任何一种，疼痛控制效果都会大打折扣。与其他组相比，第6组的管理方法在第1天对疼痛的控制也更为有效。第6组患者服用的可待因片比其他任何组都少。此外，第6组在其他几个研究方面得分最高：a）第1天的光敏感度；b）第1天的流泪情况；c）第1天的嗜睡情况；d）第一晚的睡眠时间。所有患者的上皮均愈合，但第5组和第6组各有一名患者的上皮缺损持续超过7天。未发生感染性角膜炎病例，也未出现与局部使用非甾体抗炎滴眼液相关的无菌性角膜炎病例。
