Phenylephrine/Ketorolac Solution May Cut Need for Opioids During Cataract Surgery

This article is part of MPR’s coverage of the American Academy of Ophthalmology 2019 Meeting, taking place in San Francisco, CA. Our staff will report on medical research related to eye disorders, conducted by experts in the field. Check back regularly for more news from AAO 2019..

SAN FRANCISCO – Administering phenylephrine/ketorolac 1%/0.3% intraocular solution reduces pain and opioid usage during cataract surgery, according to data presented at the 2019 American Academy of Ophthalmology Meeting in San Francisco, CA.

The intraocular solution (Omidria; Omeros), which combines an alpha 1-adrenergic receptor agonist with a nonselective cyclooxygenase inhibitor, is currently approved by the Food and Drug Administration for use during cataract surgery or intraocular lens replacement. When added to an ocular irrigating solution, it is indicated for maintaining pupil size by preventing intraoperative miosis and reducing postoperative ocular pain.

To investigate the effect of phenylephrine/ketorolac 1%/0.3% on opioid use, researchers assigned 60 patients to receive the combination intracamerally or epinephrine; patients were also treated with lidocaine (topical and intracameral) and were allowed to request intravenous fentanyl during cataract surgery if needed. The primary outcome measures included visual analog scale pain scores during surgery and need for IV fentanyl.

Results showed reduced pain levels in the study group compared with the epinephrine group (mean pain score: 2.3 vs 4.5, respectively; P<.0001). With regard to fentanyl use, 9.8% of patients requested analgesia in the phenylephrine/ketorolac 1%/0.3% group, compared with 42.1% in the epinephrine group (odds ratio: 6.7 [1.7, 26.6]; P=.0006). The analysis showed that patients who received phenylephrine/ketorolac 1%/0.3% were 94% less likely to need fentanyl or to have moderate-to-severe pain.

Based on their findings, the authors concluded that “these results suggest that use of intracameral phenylephrine/ketorolac 1%/0.3% during cataract surgery can significantly reduce patient pain as well as the need for opioids.”

Reference

Donnenfeld, E. The Effect of Phenylephrine and Ketorolac Intracameral Solution 1%/0.3% on Pain and Opioid Usage During Cataract Surgery. Poster number: PO040. The American Academy of Ophthalmology Meeting; October 12-15 2019.