Randomized, controlled crossover comparison of oral cannabidiol with oral opioid for postoperative PRK pain control.

PURPOSE: To compare the safety and efficacy of low-tetrahydrocannabinol (THC) oral cannabidiol (CBD) with oral codeine-acetaminophen for postoperative pain control after photorefractive keratectomy.

SETTING

Academic outpatient clinical practice.

DESIGN

Prospective, randomized, crossover, self-controlled clinical trial.

METHODS

35 adults underwent bilateral sequential PRK, receiving oral CBD (50 mg twice daily) for one eye and oral T3 (codeine-acetaminophen 30 to 300 mg every 4 hours) for the contralateral eye in a randomized sequence. Primary outcomes included pain and uncorrected visual acuity at month 3. Secondary outcomes included diary-reported symptoms and patient-reported quality-of-life scores: Patient-Reported Outcomes With LASIK, Quality-of-Life Impact of Refractive Correction, and Ocular Surface Disease Index.

RESULTS

Pain scores peaked on postoperative day 2 across both interventions with no significant difference in mean or maximum pain ratings ( P = .538). Visual acuity improved significantly by postoperative month 3 ( P < .001), with no treatment-related differences ( P = .928). Sensorium was significantly higher when taking CBD for the first eye, and not the second eye, indicating first-exposure effect ( P = .035). Other symptoms and outcomes were equivalent between treatments.

CONCLUSIONS

Low-THC oral CBD provides noninferior pain control to codeine-acetaminophen after PRK with similar recovery outcomes and minimal side effects. Mild sensorium changes may occur in surgically naïve patients taking CBD. CBD may represent a viable opioid-sparing alternative in refractive surgery or acute pain management.