Elsevier

Ophthalmology

Volume 116, Issue 6, June 2009, Pages 1168-1174
Ophthalmology

Original article
Oral versus Topical Diclofenac for Pain Prevention during Panretinal Photocoagulation

Presented as a poster at: American Academy of Ophthalmology Annual Meeting, November 2008, Atlanta, Georgia.
https://doi.org/10.1016/j.ophtha.2009.01.022Get rights and content

Purpose

To investigate the effect of pretreatment oral and topical diclofenac on pain reduction during panretinal laser photocoagulation (PRP) for proliferative diabetic retinopathy (PDR).

Design

Prospective, randomized, double-masked, placebo-controlled clinical trial.

Participants and Controls

A total of 90 patients with PDR requiring PRP for the first time were assigned randomly to 1 of 3 study groups: oral diclofenac (n = 30), topical diclofenac (n = 31), or placebo (n = 29).

Methods

Study medications were administrated before the first PRP treatment, and pain levels experienced during and 15 minutes after PRP were recorded on a visual analog scale (VAS). Pain levels during a second PRP session, performed on a later date with no pretreatment medications, also were recorded on a VAS.

Main Outcome Measures

The primary outcome measures were the mean VAS pain scores during the first PRP treatment. Secondary outcome measures were the mean VAS pain scores 15 minutes after the first PRP and during the second PRP, and reported side effects after the first PRP.

Results

Mean VAS pain scores during the first PRP were: oral diclofenac, 25.7±19.9; topical diclofenac, 33.8±27.9; and placebo, 41.3±31.0. The pain score difference between oral diclofenac and placebo was both clinically significant (≥13) and statistically significant (P = 0.02), whereas differences between oral and topical diclofenac (P = 0.20) and topical diclofenac and placebo (P = 0.33) were not. Multivariate regression analysis for age, gender, and total laser energy demonstrated lower pain levels for both oral diclofenac (P = 0.015) and topical diclofenac (P<0.0001) versus placebo, but no difference between oral and topical diclofenac (P = 0.67). For the first PRP, all 3 groups had lower mean pain scores at 15 minutes after treatment compared with during treatment (P≤0.0003). Mean pain scores were higher during the second compared with the first PRP for the oral diclofenac (P = 0.02) and placebo (P = 0.05) groups. No significant rate difference for any side effect was found between groups.

Conclusions

When given in a single dose, oral diclofenac is an effective pretreatment analgesic agent for reducing the pain experienced during PRP for PDR.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

This prospective, randomized, double-masked, 3-armed placebo-controlled trial was carried out using consecutive patients from the practice of 1 vitreoretinal specialist (WCL) in the Department of Ophthalmology and Visual Sciences at the University of Toronto between November 2003 and March 2007. Ethics approval was granted by the University of Toronto University Health Network Research Ethics Board. Approval for the clinical trial was granted by the Health Canada (federal government)

Results

A total of 90 patients were recruited into the study, with 30 in the oral diclofenac group, 31 in the topical diclofenac group, and 29 in the placebo group. No patients changed groups at any time during the study. All 90 patients took their appropriate pretreatment medications (and thus were analyzed as intention to treat), underwent their first PRP treatment, and completed the 2 pain questionnaires corresponding to the first PRP session. Three patients (1 from each study group) did not have

Discussion

This study sought to investigate the level of analgesia provided by the oral and topical forms of the NSAID diclofenac when given before PRP for PDR. The idea for the study was contrived because patients typically experience pain during PRP, but there is no consensus favoring any particular pretreatment analgesic agent. In this study, plus the 4 published randomized trials that investigated pretreatment analgesic medications for PRP using the VAS scale, mean placebo group pain scores range from

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    Manuscript no. 2008-897.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the Academic Enrichment Fund, Department of Ophthalmology, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, Canada. The funding organization had no role in the design or conduct of this research.

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