Efficacy of duloxetine compared with opioid for postoperative pain control following total knee arthroplasty

Abstract

Background The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following total knee arthroplasty (TKA). Methods Among 944 patients, 290 (30.7%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated. Results There was no significant difference in pain VAS score, WOMAC Pain and Function score, at each time point between before and after surgery (all p>0.05). Fifteen (9.8%) patients in the opioid group and six (4.4%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p>0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p>0.05). There was no difference in the incidence of side effects between the two groups (p>0.05). Conclusion Duloxetine and opioid did not show any difference in pain control, function, and side effects for up to one year after TKA. Although large-scale randomized controlled trials are still required to further confirm the side effects of duloxetine, it can be considered as an alternative to opioid for postoperative pain control following TKA.

The efficacy and safety of duloxetine for the treatment of patients after TKA or THA: A systematic review and meta-analysis

“…In addition, the title list was imported into Endnote software, 152 studies which was duplicated or did not meet the inclusion criteria such as reviews, meta-analysis, animal-based studies, case report, and conference papers were excluded. After referring to the full text, 1 retrospective trial and 2 protocols were excluded, and 8 randomized controlled trial (RCT) [11,12,[18][19][20]24,29,30] with 739 patients were finally included. The study selection process and reasons for exclusion are summarized in Figure 1.…”

“…Eight RCTs [11,12,[18][19][20]24,29,30] reported the method of randomization, with 7 [11,[18][19][20]24,29,30] randomized through computer-generated lists and 1 [12] through random number table. Blinding was maintained using sealed envelopes in 8 studies, and 6 [18][19][20]24,29,30] reported blinding of the operator and participants, and 2 [11,12] reported blinding of the patients, the treating physicians and the statisticians. No study showed an unclear bias due to incomplete outcome data or selective outcome reporting.…”

“…Visual analogue scale. Data on VAS were available in 5 articles [18][19][20]24,30] including 426 patients. A random effects model was used because of significant heterogeneity (I 2 > 50%, P < .05).…”

“…[14] Duloxetine (Cymbalta), a potent selective serotonin and norepinephrine reuptake inhibitor (SNRI), influences the descending inhibitory control pathways of the central nervous system, has been widely approved for major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain (OA, fibromuscular pain, and chronic back pain, among others). [15][16][17] Duloxetine analgesia effect is independent of its antidepression effect, it has similar analgesia effects on both depressed and nondepressed patients. [18] Many prior studies have already demonstrated duloxetine could reduce acute postoperative pain in the postoperative, decrease the opioids consumption and wound complication rates as well as accelerating postoperative recovery, without increasing the risk of adverse medication effects in patients undergoing total joint arthroplasty (TJA).…”

“…[15][16][17] Duloxetine analgesia effect is independent of its antidepression effect, it has similar analgesia effects on both depressed and nondepressed patients. [18] Many prior studies have already demonstrated duloxetine could reduce acute postoperative pain in the postoperative, decrease the opioids consumption and wound complication rates as well as accelerating postoperative recovery, without increasing the risk of adverse medication effects in patients undergoing total joint arthroplasty (TJA). [12,15,19,20] Some recent meta-analysis also shows that duloxetine has a positive effect on pain in OA patients.…”