TY - JOUR
T1 - The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy
AU - Levinger, Eliya
AU - Gomel, Nir
AU - Hirsh, Ami
AU - Tenne, Maya
AU - Achiron, Asaf
AU - Levinger, Nadav
AU - Levinger, Shmuel
AU - Shemesh, Nadav
AU - Abulafia, Adi
AU - Mimouni, Michael
AU - Sorkin, Nir
N1 - Publisher Copyright:
© The Author(s), 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2025/6
Y1 - 2025/6
N2 - 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.
AB - 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.
KW - NSAID
KW - PRK
KW - analgetic
KW - nepafenac
KW - nevanac
KW - non-steroidal anti-inflammatory drug
KW - pain
KW - photorefractive keratectomy
UR - https://www.scopus.com/pages/publications/105010909998
U2 - 10.1177/25158414251349340
DO - 10.1177/25158414251349340
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C2 - 40567923
AN - SCOPUS:105010909998
SN - 2515-8414
VL - 17
JO - Therapeutic Advances in Ophthalmology
JF - Therapeutic Advances in Ophthalmology
M1 - 25158414251349340
ER -