This randomized, double-masked, placebo-controlled clinical study was conducted in 125 patients. Four
NSAIDs (
diclofenac,
flurbiprofen,
ketorolac, and
indomethacin) were tested against a placebo group (
artificial tears).
Pain levels after PRK were quantified using Present
Pain Intensity (PPI) and
Pain Rating Indices based on rank values (PRI[R]) scores, both of which were calculated using patient responses to a modified McGill
Pain Questionnaire. The PRI(R) consisted of 4 subscales-sensory (S), affective (A), evaluative (E), and miscellaneous (M)-as well as a total score (T).
RESULTS: Three hours after PRK, no differences in PPI scores were found between the
ketorolac,
diclofenac, and
indomethacin groups, whereas placebo was significantly less effective than the
NSAIDs. Patients who received
flurbiprofen reported PPI scores that were significantly lower (P < 0.001) than those of patients who received
diclofenac and
indomethacin, but PPI scores in the
flurbiprofen and the
ketorolac groups did not differ significantly. Twenty-four hours after surgery, patients treated with
flurbiprofen,
ketorolac, and
diclofenac reported the lowest PPI scores compared with those treated with
indomethacin and placebo (P < 0.001). Moreover,
flurbiprofen-treated patients also had the lowest PRI(R)T scores (P < 0.001). When the
pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the
flurbiprofen group at 24 hours (P < 0.001). The PRI(R)A score was significantly higher in the placebo and
indomethacin groups compared with the other groups (P < 0.001). At the 48- and 72-hour time points,
flurbiprofen-treated patients again reported significantly lower PPI and PRI(R)T scores (P < 0.001 for both) in pair-wise comparisons with the other treatment groups. The number of patients who self-administered additional oral
analgesics did not differ significantly between the groups. However, the mean number of
analgesic tablets used was significantly higher in the placebo group than in any
NSAID group (P < 0.001). The
ketorolac group had the largest number of patients complaining of
itching (P < 0.043). No other subjective symptoms were significantly different across groups. Finally, all
NSAIDs, except
flurbiprofen, prolonged the mean reepithelialization period slightly (P < 0.001).
CONCLUSIONS: