Efficacy and adverse events of selective serotonin noradrenaline reuptake inhibitors in the management of postoperative pain: A systematic review and meta-analysis

Schnabel, Alexander; Weibel, Stephanie; Reichl, Sylvia U; Meißner, Michael; Kranke, Peter; Zahn, Peter; Pogatzki-Zahn, Esther; Meyer-Frießem, Christine H

doi:10.1016/j.jclinane.2021.110451

Cited by 11 publications

(20 citation statements)

References 29 publications

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“…[3] Recent studies reported that increasing spinal noradrenaline is not only effective against chronic pain, but is also effective for acute pain, such as postoperative pain. [4][5][6] In these studies, however, duloxetine administered perioperatively caused side effects such as dizziness, which may delay postoperative recovery. [4] In our previous study, a single oral administration of pregabalin preoperatively reduced acute pain and opioid use in patients that underwent lumbar interbody fusion (PLIF) surgery compared with a control group.…”

Section: Introductionmentioning

confidence: 99%

Randomized active-controlled study of a single preoperative administration of duloxetine to treat postoperative pain and numbness after posterior lumbar interbody fusion surgery

et al. 2022

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Background: This prospective, randomized, double-blinded, active controlled trial assessed whether a single preoperative administration of 40 mg of duloxetine could decrease postoperative pain and numbness after posterior lumbar interbody fusion surgery (PLIF). Methods: Patients with an American Society of Anesthesiologists physical status I or II undergoing PLIF were included. At 2 hours before inducing anesthesia, patients were administered 40 mg duloxetine or 4 mg diazepam (control drug). Postoperative pain and other symptoms were evaluated on the basis of a visual analog scale, amount of fentanyl used, fentanyl dose request times, rate of use of adjunctive analgesics (diclofenac sodium or pentazocine), and lower limb numbness score (0–3) during the first 2 postoperative days. Results: Forty-six patients were randomly assigned to the duloxetine and diazepam groups (n = 23 each); 6 were lost to follow-up, and analysis was performed on data from 22 patients in the duloxetine group and 18 in the diazepam group. No significant differences were detected in the patient background, postoperative visual analog scale score at rest in the lumbar region and lower limbs, fentanyl use, rate of analgesic adjuvant use, or incidence of side effects. The numbness score in the lower limbs, however, was significantly lower in the duloxetine group. Conclusion: A single preoperative 40-mg dose of duloxetine did not improve postoperative pain after PLIF, but did improve lower limb numbness. Duloxetine may suppress neuropathic pain-like symptoms after PLIF surgery.

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Section: Introductionmentioning

confidence: 99%

Randomized active-controlled study of a single preoperative administration of duloxetine to treat postoperative pain and numbness after posterior lumbar interbody fusion surgery

et al. 2022

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“…The employed strategy is generally based on analyzing effective duloxetine doses in acute pain ( Hetta et al, 2020 ). Daily doses up to 120 mg were studied; however, higher doses were associated with an increased incidence of side effects without additional benefit ( Schnabel et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence from metanalysis by Schnabel et al who pooled safety data from clinical trials that employed selective serotonin reuptake inhibitors (SSRIs) use in the management of postoperative pain supports our findings. Schnabel reported that there was no significant difference between patients treated with duloxetine or placebo in terms of incidence of PONV ( Schnabel et al, 2021 ). These findings differed from the conclusions of another meta-analysis ( Zorrilla-Vaca et al, 2019 ), that reported a statistically lower incidence of PONV with duloxetine group compared to placebo.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

et al. 2022

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Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties.Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC.Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores.Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups (p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference (p = 0.665) for the time until the patient’s first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals (p = 0.734 and 0.572, respectively).Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC.Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123],

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“…The production of noradrenaline has been associated with both specific species (Escherichia, Saccharomyces, and Bacillus [ 117 ]) and alpha diversity levels in different studies [ 118 ]. This key neurotransmitter plays a role in pain modulation [ 86 ] and analgesia [ 119 ]. Moreover, noradrenaline plays a definite role in the mediation of inflammation [ 120 ], participating in both the acute and the chronic regulation of the immune response [ 121 ] through its effect on the autonomic nervous system [ 122 ] and regulation of the circadian rhythm [ 123 ].…”

Section: Gut Microbiome Metabolites As Possible Contributors To Painmentioning

confidence: 99%

An unexpected connection: A narrative review of the associations between Gut Microbiome and Musculoskeletal Pain

Enrico

Methé

et al. 2022

Eur Spine J

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Purpose Multiple diverse factors contribute to musculoskeletal pain, a major cause of physical dysfunction and health-related costs worldwide. Rapidly growing evidence demonstrates that the gut microbiome has overarching influences on human health and the body’s homeostasis and resilience to internal and external perturbations. This broad role of the gut microbiome is potentially relevant and connected to musculoskeletal pain, though the literature on the topic is limited. Thus, the literature on the topic of musculoskeletal pain and gut microbiome was explored. Methods This narrative review explores the vast array of reported metabolites associated with inflammation and immune-metabolic response, which are known contributors to musculoskeletal pain. Moreover, it covers known modifiable (e.g., diet, lifestyle choices, exposure to prescription drugs, pollutants, and chemicals) and non-modifiable factors (e.g., gut architecture, genetics, age, birth history, and early feeding patterns) that are known to contribute to changes to the gut microbiome. Particular attention is devoted to modifiable factors, as the ultimate goal of researching this topic is to implement gut microbiome health interventions into clinical practice. Results Overall, numerous associations exist in the literature that could converge on the gut microbiome’s pivotal role in musculoskeletal health. Particularly, a variety of metabolites that are either directly produced or indirectly modulated by the gut microbiome have been highlighted. Conclusion The review highlights noticeable connections between the gut and musculoskeletal health, thus warranting future research to focus on the gut microbiome’s role in musculoskeletal conditions.

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Efficacy and adverse events of selective serotonin noradrenaline reuptake inhibitors in the management of postoperative pain: A systematic review and meta-analysis

Cited by 11 publications

References 29 publications

Randomized active-controlled study of a single preoperative administration of duloxetine to treat postoperative pain and numbness after posterior lumbar interbody fusion surgery

Randomized active-controlled study of a single preoperative administration of duloxetine to treat postoperative pain and numbness after posterior lumbar interbody fusion surgery

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

An unexpected connection: A narrative review of the associations between Gut Microbiome and Musculoskeletal Pain

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