Pharmacological therapy for relieving pain in panretinal photocoagulation: A network meta-analysis of randomized controlled trials

A Bayesian network meta-analysis (NMA) can help compare the various types of analgesics and anesthetics used for lowering pain of panretinal photocoagulation. We carried out a systematic review and network meta-analysis to assess pharmacological interventions for relieving pain in patients undergoing panretinal photocoagulation (PRP). We included 15 randomized controlled trials and 4 crossover trials with a total of 1787 eyes and 45.83 % of the participants were female. The mean age of the participants was 55 years. 2 % peribulbar lidocaine was the only significant treatment compared to placebo (MD −2.4 (95 % CrI −4.7 to −0.20). The rank probability and SUCRA also revealed 2 % peribulbar lidocaine (0.887) as the best treatment in terms of lowering the pain scores followed by etoricoxib (0.809) and potassium diclofenac (0.727). Two per cent peribulbar lidocaine is effective for reducing procedural pain in laser treatment compared to systemic and topical medications. Future studies should evaluate drugs that can reach and act on the posterior segment of the eye.