Phenylephrine + ketorolac for pain management during cataract surgery

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Created On: 30/07/2025

This systematic review and meta-analysis scrutinized the effectiveness and safety of the 1% phenylephrine + 0.3% ketorolac in enhancing pain control and sustaining pupil dilation during eye surgery for cataracts.

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Key take away

Phenylephrine + ketorolac significantly improves pain control, reduces opioid use, and maintains pupil dilation during cataract surgery without increasing adverse events.

Background

Method

A thorough literature search was executed across PubMed, Cochrane CENTRAL, Embase, Scopus, and Web of Science databases. Included studies comprised randomized controlled trials (RCTs) and observational designs that evaluated intracameral phenylephrine/ketorolac versus various control interventions. Comparisons were made with placebo or vehicle controls, phenylephrine monotherapy, and epinephrine. Primary outcomes focused on intraoperative pain, pupil size, and adverse event rates. Meta-analytic methods employed both fixed- and random-effects models. Heterogeneity was investigated via the I² statistic.

Result

A total of 10 studies involving 220,061 volunteers were included. The use of phenylephrine/ketorolac resulted in prominent reductions in postoperative pain (RR = 0.72) and opioid consumption (RR = 0.45) when compared to vehicle and epinephrine groups. The combination also preserved greater pupil dilation (MD = 0.54 mm) with negligible heterogeneity (I² = 0%) and lowered the occurrence of severe pain (RR = 0.41). No meaningful differences were observed in adverse effects, including increased intraocular pressure, inflammation, or headaches.

Conclusion

Phenylephrine/ketorolac combination proved to be more effective in maintaining intraoperative mydriasis, alleviating postoperative discomfort, and reducing reliance on opioids, without elevating the risk of adverse events. These findings support its use as a favorable alternative to conventional agents in cataract surgery, with the potential to redefine current standards of care in pain control and pupil care.