减轻全视网膜光凝固术疼痛的前瞻性随机试验研究

Interventions for relieving pain associated with panretinal photocoagulation:A pro-spective randomized trial

Purpose:To evaluate the efficacy of pain relief by oral diazepam,acetaminophen,mefenamic acid,intramuscular ketorolac tromethamine,and peribulbar anaesthesia in panretinal photocoagulation(PRP).Methods:A total of 220 patients with proliferative diabetic retinopathy requiring PRP treatment were enrolled in this study.Before laser treatment,the patients were allocated randomly to one of eight groups:group 1:diazepam(n=22),group 2:acetaminophen(n=21),group 3:mefenamic acid(n=21),group 4:diazepam and acetaminophen(n=22),group 5:diazepam and mefenamic acid(n=22),group 6:peribulbar anaesthesia with lidocaine(n=23),group 7:intramuscular injection of ketorolac tromethamine(n=22),group 8:placebo(n=67).Pain after the laser treatment was assessed by a verbal descriptive scale.Blood pressure and heart rate were measured before and after laser treatment.Results:Patients receiving peribulbar anaesthesia had a significantly lower pain score than the control group(P=0.0001).Additionally,the peribulbar anaesthesia-treated group had the significantly least PRP-associated rise in either systolic(P=0.043)or diastolic blood pressure rates(P=0.030).There were no significant differences in pain score using other anesthetic agents when compared with the control group.There were no significant changes in heart rate after PRP treatment.Conclusion:Peribulbar anaesthesia is effective in reducing pain and blood pressure increase after PRP treatment.Oral diazepam,mefenamic acid,and acetaminophen(either alone or in combination with each other)are not effective in preventing PRP treatment-associated pain.Intramuscular injection of ketorolac tromethamine is also not effective in reducing PRP-associated pain.