The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy
Purpose: To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK). Settings: Tel-Aviv Sourasky Medical Center—a tertiary medical center. Design: Observational case-series. Methods: Setting : Refractive center. Study Population : 205 PRK pa...
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SAGE Publishing
2025-06-01
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| Series: | Therapeutic Advances in Ophthalmology |
| Online Access: | https://doi.org/10.1177/25158414251349340 |
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| author | Eliya Levinger Nir Gomel Ami Hirsh Maya Tenne Asaf Achiron Nadav Levinger Shmuel Levinger Nadav Shemesh Adi Abulafia Michael Mimouni Nir Sorkin |
| author_facet | Eliya Levinger Nir Gomel Ami Hirsh Maya Tenne Asaf Achiron Nadav Levinger Shmuel Levinger Nadav Shemesh Adi Abulafia Michael Mimouni Nir Sorkin |
| author_sort | Eliya Levinger |
| collection | DOAJ |
| description | Purpose: To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK). Settings: Tel-Aviv Sourasky Medical Center—a tertiary medical center. Design: Observational case-series. Methods: Setting : Refractive center. Study Population : 205 PRK patients grouped randomly into five according to pain-management protocols: (1) paracetamol/ibuprofen (Parac-Ibupr group, n = 39), (2) high-dose oxycodone/naloxone only (Oxy-only group, n = 45), (3) oxycodone/naloxone and postoperative 0.1%-nepafenac (Oxy-Nep group, n = 36), (4) oxycodone/naloxone and preoperative and postoperative 0.1%-nepafenac (Nep-Oxy-Nep group, n = 42), and (5) preoperative and postoperative 0.1%-nepafenac only (Nep-only group, n = 43). Preoperative nepafenac was administered three times daily for 2 days. Main Outcome Measures : 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. Results: Mean pain scores differed significantly between groups ( p < 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 ( p < 0.001). Duration of tearing was longest in the Parac-Ibupr group ( p < 0.001). Nausea/vomiting occurred in 20% of the Oxy-only group ( p < 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. Conclusion: Adding preoperative nepafenac significantly reduced pain and photophobia with complete epithelial healing. Addition of oral opiates to nepafenac treatment had little analgetic benefit. |
| format | Article |
| id | doaj-art-84b40861e6c94b60a33f1290b8dbe6b3 |
| institution | Kabale University |
| issn | 2515-8414 |
| language | English |
| publishDate | 2025-06-01 |
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| series | Therapeutic Advances in Ophthalmology |
| spelling | doaj-art-84b40861e6c94b60a33f1290b8dbe6b32025-08-20T03:30:14ZengSAGE PublishingTherapeutic Advances in Ophthalmology2515-84142025-06-011710.1177/25158414251349340The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomyEliya LevingerNir GomelAmi HirshMaya TenneAsaf AchironNadav LevingerShmuel LevingerNadav ShemeshAdi AbulafiaMichael MimouniNir SorkinPurpose: To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK). Settings: Tel-Aviv Sourasky Medical Center—a tertiary medical center. Design: Observational case-series. Methods: Setting : Refractive center. Study Population : 205 PRK patients grouped randomly into five according to pain-management protocols: (1) paracetamol/ibuprofen (Parac-Ibupr group, n = 39), (2) high-dose oxycodone/naloxone only (Oxy-only group, n = 45), (3) oxycodone/naloxone and postoperative 0.1%-nepafenac (Oxy-Nep group, n = 36), (4) oxycodone/naloxone and preoperative and postoperative 0.1%-nepafenac (Nep-Oxy-Nep group, n = 42), and (5) preoperative and postoperative 0.1%-nepafenac only (Nep-only group, n = 43). Preoperative nepafenac was administered three times daily for 2 days. Main Outcome Measures : 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. Results: Mean pain scores differed significantly between groups ( p < 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 ( p < 0.001). Duration of tearing was longest in the Parac-Ibupr group ( p < 0.001). Nausea/vomiting occurred in 20% of the Oxy-only group ( p < 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. Conclusion: Adding preoperative nepafenac significantly reduced pain and photophobia with complete epithelial healing. Addition of oral opiates to nepafenac treatment had little analgetic benefit.https://doi.org/10.1177/25158414251349340 |
| spellingShingle | Eliya Levinger Nir Gomel Ami Hirsh Maya Tenne Asaf Achiron Nadav Levinger Shmuel Levinger Nadav Shemesh Adi Abulafia Michael Mimouni Nir Sorkin The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy Therapeutic Advances in Ophthalmology |
| title | The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy |
| title_full | The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy |
| title_fullStr | The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy |
| title_full_unstemmed | The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy |
| title_short | The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy |
| title_sort | added effect of preoperative nepafenac on pain and discomfort following alcohol assisted photorefractive keratectomy |
| url | https://doi.org/10.1177/25158414251349340 |
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