PURPOSE To compare the efficacy of oral codeine plus acetaminophen versus oxycodone plus acetaminophen for severe pain control following photorefractive keratectomy (PRK). METHODS This single-center trial randomized 200 patients to receive codeine 30 mg/acetaminophen 325 mg (codeine group) or oxycodone 5 mg/acetaminophen 325 mg (oxycodone group)every 4 hours as needed for severe pain for 4 days following PRK. Patients recorded postoperative pain, tablet consumption, and tetracaine use. Patients were monitored at postoperative 1 day, 1 week, and 1, 3, and 6 months for visual acuity and follow-up. Study outcomes were mean postoperative pain, treatment and tetracaine use, and visual acuity. RESULTS Analysis of 197 patients who completed the trial (97 codeine group and 100 oxycodone group) showed mean pain scores were lower in the codeine group throughout the intervention period. Mean pain scores were higher in the oxycodone group than the codeine group on postoperative days 2 and 4 (P = .017 and P = .034, respectively). The oxycodone group consumed more tablets than the codeine group, with a difference on postoperative day 2 (P = .019), and used a greater number of tetracaine drops (P = .015). Repeated measures analysis of variance showed significant improvement in visual acuity in both groups with no difference in visual outcomes (P = .81). CONCLUSIONS Codeine/acetaminophen is as effective and safe as oxycodone/acetaminophen for pain control following PRK, with no clinical difference in overall pain control and long-term visual outcomes. This implies that treating postoperative pain after PRK with a Schedule III opioid (codeine) is effective and potentially decreases the risk of misuse by a higher regulated Schedule II opioid (oxycodone), lowering the potential for abuse and dependence. [J Refract Surg. 2021;37(9):582-589.].

中文翻译：

---

屈光性角膜切除术后疼痛控制：一项前瞻性临床试验，比较可待因与羟考酮治疗术后疼痛。

目的 比较口服可待因加对乙酰氨基酚与羟考酮加对乙酰氨基酚对光屈光性角膜切除术 (PRK) 后严重疼痛控制的疗效。方法 这项单中心试验将 200 名患者随机分配至 PRK 后 4 天，根据需要每 4 小时接受可待因 30 毫克/对乙酰氨基酚 325 毫克（可待因组）或羟考酮 5 毫克/对乙酰氨基酚 325 毫克（羟考酮组）治疗。患者记录术后疼痛、药片用量和丁卡因使用情况。在术后 1 天、1 周和 1、3 和 6 个月监测患者的视力和随访。研究结果是平均术后疼痛、治疗和丁卡因使用以及视力。结果 对完成试验的 197 名患者（97 名可待因组和 100 名羟考酮组）的分析显示，在整个干预期间，可待因组的平均疼痛评分较低。术后第 2 天和第 4 天，羟考酮组的平均疼痛评分高于可待因组（分别为 P = .017 和 P = .034）。羟考酮组比可待因组消耗更多的药片，术后第 2 天有差异 (P = .019)，并且使用更多数量的丁卡因滴剂 (P = .015)。重复测量方差分析显示，两组的视力都有显着改善，视力结果没有差异（P = .81）。结论 对于 PRK 后的疼痛控制，可待因/对乙酰氨基酚与羟考酮/对乙酰氨基酚一样有效和安全，总体疼痛控制和长期视力结果没有临床差异。这意味着用附表 III 阿片类药物（可待因）治疗 PRK 后的术后疼痛是有效的，并有可能降低监管更高的附表 II 阿片类药物（羟考酮）滥用的风险，降低滥用和依赖的可能性。[J 屈光手术。2021;37(9):582-589.]。