Postoperative Pain Trajectories and the Requirement for Rescue Analgesics Following Cataract Surgery versus Pterygium Excision: A Propensity Score-Matched Retrospective Cohort Study.

PURPOSE: To compare first-day postoperative pain trajectories and systemic rescue analgesic requirements between patients undergoing cataract surgery and pterygium excision, and to identify risk factors for heightened analgesic demand. PATIENTS AND METHODS: This retrospective cohort study used standardized Numeric Rating Scale (NRS) pain records. A 1:1 propensity score matching (PSM) algorithm was applied to control for baseline demographic and surgical confounders. The primary outcome was rescue analgesic requirement within 24 hours postoperatively. Secondary outcomes included the 24-hour pain trajectory analyzed using a linear mixed-effects model (LMM) and time to first analgesic administration evaluated using Kaplan-Meier and Cox regression analyses. RESULTS: After PSM, 135 matched patient pairs (n = 270) were included. Rescue analgesic use was higher in the pterygium group than in the cataract group (65.2% vs 11.1%; p < 0.001). Multivariable regression identified pterygium surgery as an independent risk factor for systemic analgesic demand (adjusted odds ratio [aOR] = 14.85, 95% CI: 7.62-28.94). Pain trajectories differed significantly, with the pterygium group showing an early peak between 2 and 6 hours postoperatively (LMM group-by-time interaction p < 0.001). The median time to first analgesic administration in the pterygium group was 4.8 hours. Within the pterygium cohort, recurrent lesions (aOR = 4.35), age < 55 years (aOR = 2.84), and intraoperative mitomycin C use (aOR = 2.65) independently predicted higher analgesic demand. Postoperative nausea and vomiting rates were comparable between groups. CONCLUSION: Pterygium excision was associated with greater early postoperative pain and rescue analgesic use than cataract surgery. These findings support consideration of individualized, procedure-specific, multimodal pain management, particularly for high-risk pterygium patients.