Efficacy and Safety of Transdermal Fentanyl in the Control of Postoperative Pain After Photorefractive Keratectomy

Lee, Yong Woo; Kim, Yang Jae; Kim, Joon Mo; Bae, Jeong Hun; Choi, Chul Young

doi:10.1089/jop.2013.0125

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…While opioids have proven effective analgesics in a wide range of ophthalmic settings, attention is turning to how they are used in ophthalmology . Patel and Sternberg conducted a study characterizing opioid-prescription patterns by ophthalmologists within Medicare.…”

Section: Introductionmentioning

confidence: 99%

“…4 While opioids have proven effective analgesics in a wide range of ophthalmic settings, attention is turning to how they are used in ophthalmology. [5][6][7][8][9][10] Patel and Sternberg 11 conducted a study characterizing opioid-prescription patterns by ophthalmologists within Medicare. They showed that about 90% of ophthalmologists wrote fewer than 10 opioid prescriptions annually, and approximately 1% wrote more than 100 prescriptions annually.…”

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confidence: 99%

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Association of Opioids With Incisional Ocular Surgery

Kolomeyer

VanderBeek

2019

JAMA Ophthalmol

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he last few decades have seen a considerable increase in opioid-associated deaths in the United States. As per the US Centers for Disease Control and Prevention, more than 200 000 people have died from opioidassociated overdoses in the United States from 1999 through 2016, with 5 times more people dying from prescription opioids in 2016 than in 1999; in US adults younger than 50 years, drug overdose has become the number 1 cause of mortality, and the rates are higher in men than women and higher in non-Hispanic white individuals than other racial/ethnic groups. 1,2 In addition, the rates are increasing in the older population as well. 3 This prompted the establishment of a 5-point plan to combat opioid abuse, misuse, and overdose by the US Department of Health and Human Services in 2017. 4 While opioids have proven effective analgesics in a wide range of ophthalmic settings, attention is turning to how they are used in ophthalmology. [5][6][7][8][9][10] Patel and Sternberg 11 conducted a study characterizing opioid-prescription patterns by ophthalmologists within Medicare. They showed that about 90% of ophthalmologists wrote fewer than 10 opioid prescriptions annually, and approximately 1% wrote more than 100 prescriptions annually. Charlson and coworkers 12 specifically focused on oculoplastic surgeons and found that they wrote a mean of 45 opioid prescriptions per year, with 45% writing fewer than 10 and 14.8% writing IMPORTANCE Opioid abuse has been declared a public health emergency. Currently, little is known about the association between opioids and ocular surgery. OBJECTIVE To characterize rates of filled opioid prescriptions after incisional ocular surgeries. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included patients with incisional ocular surgeries within a large national US insurer's administrative medical claims database. All incisional ocular surgeries from January 2000 through December 2016 were evaluated. An opioid prescription was eligible if it occurred from 1 day before to 7 days after a surgery. Any surgery on a patient who was younger than 18 years, had more than 30 consecutive days of an opioid prescription in the prior 6 months, or had less than 6 months of data in the database prior to surgery was excluded. Data analysis occurred from May 2018 through November 2018. MAIN OUTCOMES AND MEASURESThe rate of opioid prescriptions filled for all incisional ocular surgeries from 2000 through 2016. Primary analysis looked at the rate of filled opioid prescriptions for each ophthalmic subspecialty surgery over time. Secondary analysis assessed which patient or surgical characteristics (ie, age, sex, race/ethnicity, geographic locations, yearly income, educational level, and type of eye surgery) were associated with filling an opioid prescription. Multivariate logistic regression using generalized estimating equations was used to determine odds ratios (ORs) of filling an opioid prescription.RESULTS A total of 2 407 962 incisional ocular surgeries were included, of which 45 776 (1.90%) were as...

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Association of Opioids With Incisional Ocular Surgery

Kolomeyer

VanderBeek

2019

JAMA Ophthalmol

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“…However, in the current state of intra-operative analgesia during modern phacoemulsification techniques, such as the Rand-Stein protocol [17] along with other methods of intra-operative analgesia [18][19][20], there are few reasons, if any, to prescribe postoperative opioids to an opioid-naı ¨ve patient following cataract surgery. Other ophthalmic surgeries, though, including trauma, strabismus, vitreoretinal, oculoplastic, and cornea have more varied approaches to improving postoperative pain and thus postoperative opioids may be necessary [21,22,[23][24][25][26], with the majority of this research focusing on patients undergoing refractive surgery [19,23,25,27,28]. Some interesting modalities have been studied, such as the use of pregabalin and gabapentin, nonsteroidal anti-inflammatory drugs, acetaminophen, and bandage contact lenses.…”

Section: Efforts To Reduce Opioid Prescriptions Amongst Ophthalmologistsmentioning

confidence: 99%

Opioids and ophthalmology: review of the current literature

Starr

Patel

Ammar

et al. 2021

Current Opinion in Ophthalmology

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Purpose of reviewThe number of opioid-related overdose deaths has rapidly increased since 2000, increasing more than fivefold from 1999 to 2016. Although surgeons only write 10% of opioid prescriptions annually, with ophthalmologists writing only a fraction of this amount, all physicians need to be cognizant of the current opioid epidemic and ways to decrease unnecessary opioid prescriptions. Recent findingsPrevious work within ophthalmology has shown that retrobulbar anesthesia along with peri-operative intravenous or oral nonopioid analgesics can lead to decreased postoperative opioid use following ophthalmic surgery. Recent literature has shifted focus towards the use of opioid prescription guidelines in managing postoperative pain and decreasing the number of unnecessary opioids being prescribed by ophthalmologists. Overall, the frequency of opioid prescriptions may have gradually declined the past few years with such efforts, increased awareness, and new healthcare policies to monitor opioid prescriptions. However, ophthalmologists still continue to prescribe a substantial number of opioid medications, much of which may not be necessary.

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“…Postoperative pain management in PRK has been explored by many researchers in recent years (5,(8)(9)(10)(11)(12)15,16) . However, subjective indexes of health and well-being that take place outside the clinical encounter have been rarely investigated and are typically disregarded in Arq Bras Oftalmol.…”

Section: Comparison With Previous Investigationsmentioning

confidence: 99%

“…However, despite its effectiveness and safety, PRK usually involves a high level of postoperative pain and discomfort (5) , which not only adversely affects the patient's overall satisfaction with the procedure but also reduces his or her willingness to undergo the procedure again (6,7) . Therefore, improvement of patient care during the immediate PRK postoperative period has become a major clinical challenge for ophthalmologists (8)(9)(10)(11)(12) .…”

Section: Introductionmentioning

confidence: 99%

Codeine plus acetaminophen improve sleep quality, daily activity level, and food intake in the early postoperative period after photorefractive keratectomy: a secondary analysis

Pereira

Torriceli

Garcia

et al. 2021

ABO

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To determine whether codeine plus acetaminophen after photorefractive keratectomy (PRK) have beneficial effects on sleep quality, activity levels, and food intake, beyond their effect of pain relief. Methods: We enrolled 40 patients (80 eyes) in this randomized, double-blind, paired-eye, placebo-controlled, add-on trial. Each eye was treated 2 weeks apart, and the patients were randomly allocated to receive either the placebo or the intervention (30 mg codeine and 500 mg acetaminophen) (4 times a day for 4 days). Outcomes were sleep quality, daily activity level, and food intake within 24-72 h post-photorefractive keratectomy, as measured by the McGill Pain Questionnaire. Results: Sleep quality and daily activity level were inversely associated with pain scores within the first 48 h post-photorefractive keratectomy. During the intervention, patients were significantly more likely to score their sleep quality as good at 24 h (relative risk=2.5; 95% confidence interval 1.48-4.21, p<0.001) and 48 h compared to during placebo (relative risk=1.37; 95% confidence interval: 1.03-1.84, p=0.023). The probability of reporting good daily activity level at 24 and 72 hours post-photorefractive keratectomy was three times higher when patients received the intervention compared to the placebo (relative risk=3.0; 95% confidence interval: 1.49-6.15, p=0.006 and relative risk=1.31; 95% confidence interval: 1.02-1.67, p=0.021, respectively). No difference was observed in food intake. Conclusion: The oral combination of codeine and acetaminophen significantly improves sleep quality and daily activity level within the first 24-72 h post-photorefractive keratectomy compared to a placebo.

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Efficacy and Safety of Transdermal Fentanyl in the Control of Postoperative Pain After Photorefractive Keratectomy

Abstract: 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.

Cited by 8 publications

References 35 publications

Association of Opioids With Incisional Ocular Surgery

Association of Opioids With Incisional Ocular Surgery

Opioids and ophthalmology: review of the current literature

Codeine plus acetaminophen improve sleep quality, daily activity level, and food intake in the early postoperative period after photorefractive keratectomy: a secondary analysis

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