Comparison of the Analgesic Effect of Nepafenac 0.1%,
Ketorolac 0.5%, and Diclofenac 0.1% Ophthalmic Solution
during Intravitreal Injection
Nattawat Wongchaikanakorn MD¹, Yodying Dangprapai MD, PhD²
Affiliation : ¹ Department of Ophthalmology, Taksin Hospital, Bangkok, Thailand ² Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background: Pain during intravitreal injection (IVT) is inevitable and might reduce the patient’s compliance. Topical anesthetic eye drop usually
is administered to reduce pain during IVT. However, severe ocular pain has been reported in some patients. The most effective anesthesia for
IVT is still controversy.
Objective: To evaluate the analgesic effect of three topical non-steroidal anti-inflammatory drugs (NSAIDs) eye drop, nepafenac 0.1%, ketorolac 0.5%, and diclofenac 0.1%, during IVT.
Materials and Methods: The present study was a prospective randomized, double-blinded, placebo-controlled study. Patients undergoing intravitreal bevacizumab injections were randomly divided into four groups. Group 1, group 2, group 3, and group 4 received topical nepafenac 0.1%, topical ketorolac 0.5%, diclofenac 0.1%, and artificial tear (placebo), respectively. One hour after receiving the eye drops, all patients underwent IVT with topical anesthetic eye drop. Pain assessment was performed immediately after IVT using the Thai version of Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ consists of the main component of the SF-MPQ, the visual analogue scale (VAS), and the present pain intensity (PPI).
Results: Eighty patients voluntarily enrolled in the present study. Median of VAS scores were 1.5 (0.8 to 4.6), 2.3 (1.5 to 4.6), 1.5 (1 to 3.2), and 2.4 (1.4 to 3.6) in nepafenac group, ketorolac group, diclofenac group, and placebo group, respectively (p=0.159). Median of the main component of the SF-MPQ scores were 4 (1.25 to 5.75), 5 (2.25 to 11.5), 5 (1.25 to 9.5), and 5 (3 to 13), in nepafenac group, ketorolac group, diclofenac group and placebo group, respectively (p=0.409). Median of the PPI scores were 1 (1 to 1.75), 1 (1 to 2), 1 (1 to 1), and 1 (1 to 2), in nepafenac group, ketorolac group, diclofenac group, and placebo group, respectively (p=0.529).
Conclusion: There were no significant differences in analgesic effect during IVT between topical NSAIDs, nepafenac 0.1%, ketorolac 0.5%, diclofenac 0.1%, and placebo.
Received 22 February 2021 | Revised 21 April 2021 | Accepted 21 April 2021
doi.org/10.35755/jmedassocthai.2021.06.12592
Keywords :
Intravitreal injection; Analgesic effect; Topical NSAIDs eye drop; SF-MPQ
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