SAMIR JACOB BECHARA
Projetos de Pesquisa
Unidades Organizacionais
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
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- Mechanisms of Corneal Pain and Implications for Postoperative Pain After Laser Correction of Refractive Errors(2016) GARCIA, Renato; ANDRADE, Daniel C. de; TEIXEIRA, Manoel J.; NOZAKI, Siro S.; BECHARA, Samir J.Objective:The cornea is the target of most surgeries for refractive disorders, as myopia. It is estimated that almost 1 million patients undergo corneal refractive surgery each year in the United States. Refractive surgery includes photorefractive keratectomy (PRK) that produces intense postoperative pain. This review presents the main pain mechanisms behind PRK-related pain and the available therapeutic options for its management.Methods:Data sources included literature of cornea anatomy, treatment of PRK postoperative pain, mechanisms of corneal pain, in 3 electronic databases: Pubmed, Scopus, and Web of Science. Only double-blinded controlled trials on pain control after PRK were selected to show the endpoints, treatment, and control strategies.Results:A total of 18 double-blind, controlled trials were identified. These studies have shown the use of topical nonsteroidal anti-inflammatory drugs, topical steroidal anti-inflammatory drugs, systemic analgesics, cold balanced saline solution, topical anesthetic, gabapentin, and morphine to treat postoperative pain in PRK.Discussion:The percentage of responders has seldom been reported, and few studies allow for the formal calculation of the number necessary to treat. Postoperative intense pain after PRK laser surgery remains the main challenge to its widespread use for the correction of refractive errors.
article 9 Citação(ões) na Scopus Predictors of Early Postoperative Pain After Photorefractive Keratectomy(2016) GARCIA, Renato; TORRICELLI, Andre Augusto Miranda; MUKAI, Adriana; PEREIRA, Vinicius Borges Porfirio; BECHARA, Samir JacobPurpose: To compare the profiles of postoperative photorefractive keratectomy (PRK) pain between both eyes under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE). Methods: This prospective study included 86 eyes of 43 patients with myopia who underwent PRK in both eyes at an interval of 14 days between the procedures. Before surgery, subjects answered the State Anxiety Inventory. After surgery, usual PRK pain treatment was given. Subjects answered the Visual Analog Scale, the Brief Pain Inventory (BPI), and the McGill Pain Questionnaire at 1, 24, 48, 72, and 96 hours after surgery. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test, respectively. The Wald test was performed for gender and SERE for each eye separately. Results: There were no statistically significant differences between both eyes for all time points regarding the Visual Analog Scale, BPI, and McGill Pain Questionnaire Pain Rating Index pain scores. Subjects were less anxious on average before the second surgery compared with before the first surgery (P < 0.001); however, it was not related to pain ratings after surgery. Gender did not significantly affect any scale of pain, and the SERE between 3 diopters (D) and 5 D (P = 0.035) revealed effects on the BPI. Conclusions: The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK.- Codeine Plus Acetaminophen for Pain After Photorefractive Keratectomy: A Randomized, Double-Blind, Placebo-Controlled Add-On Trial(2017) PEREIRA, Vinicius B. P.; GARCIA, Renato; TORRICELLI, Andre A. M.; MUKAI, Adriana; BECHARA, Samir J.Background: Pain after photorefractive keratectomy (PRK) is significant, and the analgesic efficacy and safety of oral opioids in combination with acetaminophen has not been fully investigated in PRK trials. Purpose: To assess the efficacy and safety of the combination of codeine plus acetaminophen (paracetamol) versus placebo as an addon therapy for pain control after PRK. Study design: Randomized, double-blind, placebo-controlled trial. Setting: Single tertiary center. Methods: One eye was randomly allocated to the intervention, whereas the fellow eye was treated with a placebo. Eyes were operated 2 weeks apart. The participants were adults older than 20 years with refractive stability for >= 1 year, who underwent PRK for correction of myopia or myopic astigmatism. Codeine (30 mg) plus acetaminophen (500 mg) was given orally 4 times per day for 4 days after PRK. The follow-up duration was 4 months. The study outcomes included pain scores at 1 to 72 hours, as measured by the visual analog scale, McGill Pain Questionnaire, and Brief Pain Inventory, as well as adverse events and corneal wound healing. Results: Of the initial 82 eyes, 80 completed the trial (40 intervention, 40 placebo). Median (interquartile range) pain scores as measured by the visual analog scale were statistically and clinically lower during treatment with codeine/acetaminophen compared with the placebo: 1 hour: 4 (2-4) versus 6 (3-6), P, 0.001; 24 hours: 4 (3-6) versus 7 (6-9), P < 0.001; 48 hours: 1 (02) versus 3 (2-5), P < 0.001; and 72 hours: 0 (0-0) versus 0 (0-2), P = 0.001. Virtually identical results were obtained by the McGill Pain Questionnaire and Brief Pain Inventory scales. The most common adverse events with codeine/acetaminophen were drowsiness (42%), nausea (18%), and constipation (5%). No case of delayed epithelial healing was observed in both treatment arms. Conclusions: When added to the usual care therapy, the oral combination of codeine/acetaminophen was safe and significantly superior to the placebo for pain control after PRK.
article 20 Citação(ões) na Scopus Opioids for Ocular Pain - A Narrative Review(2017) PEREIRA, Vinicius B. P.; GARCIA, Renato; TORRICELLI, Andre A. M.; BECHARA, Samir J.Background: Refractive surgery is a common procedure, but may be associated with severe post-operative pain. Objectives: To describe studies addressing the use of opioids for control of pain after ocular surgery, with an emphasis on refractive surgery. Study Design: This is a narrative review of relevant articles on the physiology of corneal pain and the use of opioids for its treatment after surgery. Setting: Single tertiary center. Methods: A PubMed search was conducted for studies published from January 1985 to May 2015 on the physiopathology of corneal pain and opioid treatment of post-refractive surgical pain. Reviews, meta-analyses, and randomized clinical trials were included. Inclusion criteria focused on photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). Results: Authors found 109 articles through the search strategies. A total of 75 articles were included based on the inclusion criteria. Discussion: Pain after ocular surgery is likely to be a multifactorial phenomenon. A combination of topical and systemic analgesics is used to treat post-operative pain after refractive surgery. Pain may be severe during the first 72 to 96 hours, depending on the surgical procedure. No studies were found that directly analyze the benefits of opioids after PRK, although they are routinely prescribed in some centers. Limitations: This is a narrative review in contrast to a systematic review and did not include studies indexed in databases other than PubMed. Conclusions: Although opioids are used for the short-term treatment of post-operative pain in refractive surgery, their benefits and risks should be properly evaluated in randomized clinical trials before their use can be safely advised.- Improved Evaluation of Postoperative Pain After Photorefractive Keratectomy(2016) GARCIA, Renato; HOROVITZ, Roberto Novaes Campello; TORRICELLI, Andre Augusto Miranda; MUKAI, Adriana; BECHARA, Samir JacobPurpose:Postoperative pain remains an important limiting factor to the selection of photorefractive keratectomy (PRK). There is a consensus in neurology pain research that pain should be evaluated as a multidimensional concept, which differs from current practice in ophthalmology. The purpose of this paper was to validate the use of multidimensional questionnaires, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ), to provide an improved analysis of pain after PRK and to better describe its temporal profile.Methods:This prospective study included 43 eyes of 43 myopic patients who underwent unilateral PRK. After surgery, usual pain treatment was administered. All of the participants responded to the Visual Analogue Scale (VAS), the BPI and the MPQ 1, 24, 48, 72, and 96 hours after surgery. The internal consistency was evaluated, different postoperative periods were compared, and convergent validity was assessed using correlation testing.Results:The Cronbach alpha test showed high internal consistency for each of the questionnaire subscales. Patients reported higher postoperative pain values at the first measurement of the VAS (4.93 2.38), MPQ-pain rating index (26.95 +/- 10.58), BPI-pain severity index (14.53 +/- 7.36), and BPI-pain interference index (22.30 +/- 15.13). Almost all of the scales and subscales showed a statistically significant direct correlation with the VAS at all of the evaluation periods.Conclusions:This study validated the utility of multidimensional questionnaires to expand the assessment of the PRK postoperative pain profile, including intensity and other qualitative aspects.
- Codeine plus acetaminophen improve sleep quality, daily activity level, and food intake in the early postoperative period after photorefractive keratectomy: a secondary analysis(2021) PEREIRA, Vinicius B. P.; TORRICELI, Andre A. M.; GARCIA, Renato; BECHARA, Samir J.; ALVES, Milton R.Purpose: To determine whether codeine plus acetaminophen after photorefractive keratectomy (PRK) have beneficial effects on sleep quality, activity levels, and food intake, beyond their effect of pain relief. Methods: We enrolled 40 patients (80 eyes) in this randomized, double-blind, paired-eye, placebo-controlled, add-on trial. Each eye was treated 2 weeks apart, and the patients were randomly allocated to receive either the placebo or the intervention (30 mg codeine and 500 mg acetaminophen) (4 times a day for 4 days). Outcomes were sleep quality, daily activity level, and food intake within 24-72 h post-photorefractive keratectomy, as measured by the McGill Pain Questionnaire. Results: Sleep quality and daily activity level were inversely associated with pain scores within the first 48 h post-photorefractive keratectomy. During the intervention, patients were significantly more likely to score their sleep quality as good at 24 h (relative risk=2.5; 95% confidence interval 1.48-4.21, p<0.001) and 48 h compared to during placebo (relative risk= 1.37; 95% confidence interval: 1.03-1.84, p=0.023). The probability of reporting good daily activity level at 24 and 72 hours post-photorefractive keratectomy was three times higher when patients received the intervention compared to the placebo (relative risk=3.0; 95% confidence interval: 1.49-6.15, p =0.006 and relative risk=1.31; 95% confidence interval: 1.02-1.67, p=0.021, respectively). No difference was observed in food intake. Conclusion: The oral combination of codeine and acetaminophen significantly improves sleep quality and daily activity level within the first 24-72 h post-photorefractive keratectomy compared to a placebo.
- Preoperative Predictors for Acute Pain After Photorefractive Keratectomy(2022) TOYOTA, Adriana M.; GARCIA, Renato; TORRICELLI, Andre A. M.; SILVA, Valquiria A.; GALHARDONI, Ricardo; TEIXEIRA, Manoel J.; ANDRADE, Daniel C. de; BECHARA, Samir J.Purpose: The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain. Methods: This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors. Results: This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05). Conclusions: Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.