Cataract Surgery Protocol Reduces Opioid Reliance

Cataract surgery
treatment of a cataract by a surgical method
The system significantly decreases prescription levels in 1 ophthalmology clinic.

Intracameral phenylephrine 1.0%–ketorolac 0.3% (P/K) can offer a nonopioid alternative for both intraoperative and early postoperative pain associated with cataract surgery, according to research published in the Journal of Cataract and Refractive Surgery.

A single-center trial compared both intracameral P/K and epinephrine approaches, and examined their associations with the use of opioids in patients undergoing bilateral sequential cataract surgery. The researchers included 112 eyes of 56 adult participants (mean age 70.1±7.09). For this research, 28 patients were given epinephrine for the first eye, followed 2 weeks later by P/K for the second eye. The other 28 received P/K in the first eye, followed by epinephrine in the second. All surgeries were conducted using topical lidocaine gel anesthesia. Researchers monitored for the need for intraoperative fentanyl based on patient request or surgeon discretion. They also documented postoperative pain measurements, surgery duration, effective phacoemulsification time, pupil size, and any surgical complications.

The report shows that intraoperative fentanyl was required in significantly fewer eyes when P/K was used compared with epinephrine (7 [12.5%] vs 19 [33.9%]; P =.013). Use of P/K also resulted in significantly lower mean pain scores throughout the study, with ‘no pain’ to ‘low pain’ reported in 85.7% (n=48) of the P/K patients vs 58.9% (n=33) of the epinephrine patients intraoperatively. When compared with the control group, the P/K group had significantly higher intraocular ratings of ‘no pain’ to ‘mild pain’ (58.9% vs 82.1%, P =.013, respectively), significantly decreased operating room time (7.6±1.3 minutes vs 6.9±1.2 minutes, P =.004, respectively), and significantly larger pupil during surgery (6.5 mm vs 7.2 mm, P <.001). 

The use of P/K significantly reduced the need for fentanyl both intraoperatively and postoperatively, researchers report. This finding aligns with previous research. As opioid misuse and abuse is common among patients between the ages of 50 and 80 years, a group also likely to be undergoing cataract surgery, researchers advise that clinicians consider the use of P/K to avoid these risks. 

A limitation of this study is its single center design, but researchers argue that using one eye in each patient to create a control group decreases the effects of this design feature. Also, postoperative opioid use was not measured in the study but instead assumed from the pain scales collected.


Donnenfeld ED, Mychajlyszyn D, Mychajlyszyn A, Stein R. Pain control and reduction of opioid use associated with intracameral phenylephrine 1.0%-ketorolac 0.3% administered during cataract surgery. J Cataract Refract Surg. 2022;48(7):759–764. doi:10.1097/j.jcrs.0000000000000855.