Purpose: To evaluate the efficacy and safety of transdermal fentanyl (TDF) in the control of postoperative pain following photorefractive keratectomy (PRK).
Methods: One hundred ninety-nine consecutive PRK cases (398 eyes) were retrospectively reviewed. For postoperative pain control, 96 patients (63 females) were treated with tramadol 37.5 mg/acetaminophen 325 mg combination tablets (2 tablets bid), 103 patients (73 females) were treated with TDF (12 μg/h). Postoperative pain intensity using the visual analog scale (VAS) during postoperative 3 days including the evening of the day of the operation and peak pain intensity, rated using the verbal descriptor scale (VDS) at postoperative 4 days, were compared between 2 groups. Overall adverse events in the 2 treatment groups were also compared.
Results: The differences in mean pain intensity scores were significant between the control group and the fentanyl group (P=0.001, Repeated-measures analysis of variance). The proportion of severe pain (VAS>54 mm) was significantly lower in the fentanyl group than the control group by morning of postoperative 2 days (P<0.007). The proportion of patients who rated their peak pain intensity as "intolerable pain" was significantly higher (P=0.001) in the control group (30/96, 31.3%) than the fentanyl group (13/103, 12.6%). Total number of patients who reported adverse events was significantly higher in the fentanyl group (P=0.013) than the control group. However, there were no irreversible or severe adverse events in both treatment groups and nausea was the most common (14/103, 13.6%) complaint reported in the fentanyl group.
Conclusion: TDF was more effective in the control of postoperative pain after PRK than tramadol/acetaminophen and no irreversible or severe adverse effect was reported with 12 μg/h concentration. TDF could be considered as alternative regimen of analgesic method after PRK.