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 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.