Preemptive Analgesic Effect of Topical NSAIDS in Postoperative Pain Relief after LASEK

Se Kyung Kim; Jin Pyo Hong; Sang Min Nam; Kyoung Yul Seo

doi:10.3341/jkos.2011.52.12.1414

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Kim, Hong, Nam, and Seo: Preemptive Analgesic Effect of Topical NSAIDS in Postoperative Pain Relief after LASEK

Original Article

J Korean Ophthalmol Soc 2011;52(12):1414-1418.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.12.1414

Preemptive Analgesic Effect of Topical NSAIDS in Postoperative Pain Relief after LASEK

Se Kyung Kim, MD¹, Jin Pyo Hong, MD², Sang Min Nam, MD³, Kyoung Yul Seo, MD, PhD¹

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Seyan Eye Center, Seoul, Korea

³Department of Ophthalmology, Bundang CHA Hospital, CHA University, Seongnam, Korea

Address reprint requests to Kyoung Yul Seo, MD, PhD Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine #134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541, E-mail: seoky@yuhs.ac

Received 28 March 201127 April 2011 Accepted 30 September 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the preemptive analgesic effect of topical NSAIDs (0.5% ketorolac tromethamine, Acular) as postoperative pain relief in patients undergoing LASEK.

Methods

A prospective, randomized, placebo-controlled, paired eye study was performed. Patients undergoing LASEK were randomized to receive 0.5% ketorolac in one eye and 0.3% ofloxacin (placebo) in the contralateral eye at 30 minutes, 20 minutes, or ten minutes prior to LASEK. Pain was assessed using a visual analog scale of 0 to 10 in each eye 6, 12, 24, 36, 48 and 72 hours after surgery. Patients were also asked to assess the levels of glare, tearing and irritation using a visual analog scale from 0 to 10.

Results

A total of 62 eyes from 31 patients were enrolled in the present study. The mean postoperative pain score in the NSAID group was significantly lower than that in the placebo group at postoperative hours 6 (2.35 versus 4.97), 12 (2.52 versus 5.16), and 24 (3.84 versus 4.94) (p < 0.05). The mean postoperative pain score after 36 and 48hours was also lower in the NSAID group than in the placebo group, but the differences were not statistically significant (p > 0.05). Patients reported significantly less tearing and irritation in the NSAID-administered eye compared to those in the placebo eye after LASEK (p < 0.05).

Conclusions

Preemptive administration of topical NSAIDs before LASEK was effective in reducing acute postoperative pain. Preemptive analgesia with topical NSAIDs may be a valuable treatment option for controlling postoperative pain following ocular surgery.

Keywords: LASEK, Nonsteroidal anti-inflammatory drug, Pain, Preemptive analgesia

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Figure 1.

Pain score change on each postoperative hour. VAS = visual analog scale; NSAID = non steroidal anti-inflammatory drug. ^∗p < 0.05.

Table 1.

Patient characteristics

	Overall	NSAID (N = 31)	Placebo (N = 31)	p-value^∗
Sex (n, %)
Male	13 (41.9)
Female	18 (58.1)
Age (yr)
Mean ± SD	28.23 ± 6.73
Range	20∼41
Refractive error (SE, D)
Mean ± SD	‐4.63 ± 2.07	‐4.47 ± 2.07	‐4.78 ± 2.09	0.54
Range	‐1.37∼‐9.57	‐1.37∼‐9.07	‐1.50∼‐9.57
Ablation depth (mean ± SD, um)	86.51 ± 32.14	84.00 ± 32.79	89.11 ± 31.83	0.24

NSAID = non steroidal anti-inflammatory drug; SD = standard deviation; SE = spherical equivalent.

^∗ p-value by paired t-test.

Table 2.

Postoperative pain score after LASEK (VAS score)

Postoperative hour	NSAID (N = 31) Mean ± SD	Placebo (N = 31) Mean ± SD	p-value^∗
6	2.35 ± 1.87	4.97 ± 2.83	<0.001
12	2.52 ± 2.35	5.16 ± 3.13	<0.001
24	3.84 ± 3.08	4.94 ± 3.05	0.03
36	4.23 ± 3.19	4.77 ± 3.12	0.06
48	2.71 ± 2.60	2.81 ± 2.57	0.66
72	0.48 ± 0.89	0.39 ± 0.84	0.26

LASEK = laser assisted subepithelial keratomileusis; VAS = visual analog scale; NSAID = non steroidal anti-inflammatory drug; SD = standard deviation.

^∗ p-value by paired t-test.

Table 3.

Glare, tearing, irritation after LASEK (VAS score)

	NSAID (N = 31) Mean ± SD	Placebo (N = 31) Mean ± SD	p-value^∗
Glare	2.52 ± 1.55	2.61 ± 1.38	0.33
Tearing	2.58 ± 1.59	3.68 ± 1.62	0.001
Irritation	2.55 ± 1.50	3.26 ± 1.46	0.02

LASEK = laser assisted subepithelial keratomileusis; VAS = visual analog scale; NSAID = non steroidal anti-inflammatory drug; SD = standard deviation.

^∗ p-value by paired t-test.

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