Impact of duloxetine and dexamethasone for improving postoperative pain after laparoscopic gynecological surgeries: A randomized clinical trial

Abstract

Background:Patients’ surgical experiences are influenced by their perception of pain management. Duloxetine (Dulox) and dexamethasone (Dex) are used in multimodal analgesia to reduce opioid use and side effects. Dulox is a selective serotonin and norepinephrine reuptake inhibitor and has efficacy in chronic pain conditions. Dex enhances postoperative (PO) analgesia and reduces PO nausea and vomiting (PONV).Methods:Seventy-five female patients were randomly allocated into one of three equal groups. GI received Dulox 60 mg orally and 100 ml 0.9% sodium chloride (normal saline [NS]) intravenous infusion (IVI) over 15 min, GII: received as GI except Dex 0.1 mg/kg was mixed with NS and GIII received identical placebo for Dulox capsule and Dex IVI, 2 h preoperatively. Patients’ vitals, visual analog scale (VAS), and sedation score were assessed at 30 min, 1 h, 2 h, 6 h, and 12 h postoperatively. Total pethidine requirements, plasma cortisol, PONV, and patients satisfaction were recorded.Results:PO time for 1st rescue analgesic was significantly high in GI and GII compared to GIII and in GII compared to GI. There was a significant less VAS score, heart rate, mean arterial pressure, and a high sedation score in GI and GII compared to GIII at 30 min, 1, 2, and 6 h postoperatively. Total pethidine requirements were significantly less in GI and GII compared to GIII 12 h postoperatively. There was a significant reduction in the 2 h PO serum cortisol (μg/dl) and a significant increase in the PO patients satisfaction score in GI and GII compared to GIII. PONV was decreased significantly in GII compared to GI and GIII.Conclusion:The use of oral Dulox 60 mg combined with Dex 0.1 mg/kg IVI is more effective than oral Dulox 60 mg alone, 2 h preoperatively, for improving PO pain by reducing the requirements for rescue analgesia and PONV.

The Efficacy of Preoperative Duloxetine in Patients Undergoing Major Abdominal Cancer Surgery

“…Duloxetine had been recently used as a coanalgesic in many operations and provided encouraging results. 10,11,13,14,[19][20][21][22][23] Bedin et al 10 administered duloxetine 60 mg 1 hour before spine surgery and reported a significant reduction in pain scores and fentanyl consumption up to 48 hours postoperatively compared with placebo, moreover, Ho et al 14 concluded that perioperative administration of 2 doses of oral duloxetine 60 mg (2 h before knee replacement surgery and on the first postoperative day) had lowered the mean morphine requirements during the first 48 hours after surgery in the duloxetine group (19.5 ± 14.5 mg) compared with the placebo group (30.3 ± 18.1 mg) (P = 0.017), however, they did not detect significant changes between the groups in pain scores. Furthermore, Castro-Alves et al 13 had detected a reduction in pain scores, opioid consumption, and improvement in the quality of recovery after administration of duloxetine (60 mg orally 2 h before and 24 h after hysterectomy) in comparison with placebo pill; however, these effects were limited to the first 24 hours postoperatively.…”

“…Selection of duloxetine dose of 60 mg was based on our previous study conducted on women undergoing modified radical mastectomy, where we compared against placebo the analgesic efficacy of 3 doses of preoperative duloxetine (30, 60, and 90 mg) and the results showed that 60 mg is the optimum dose that provided reduced morphine requirements, lower VAS score, and higher QOR scores than 30 mg with the least side effects. 9 Unlike all the previous studies, that administered concurrent multimodal analgesics with duloxetine, such as paracetamol, 19,20 ketoprofen, 10,11 celecoxib, 21 local anesthetic infiltration, 22 or subarachnoid block, 13,14,23 we administered only morphine in conjunction with duloxetine, in such way the obtained analgesic benefit and the better quality of recovery should be merely because of the effect of duloxetine.…”

“…Unlike all the previous studies, that administered concurrent multimodal analgesics with duloxetine, such as paracetamol,19,20 ketoprofen,10,11 celecoxib,21 local anesthetic infiltration,22 or subarachnoid block,13,14,23 we administered only morphine in conjunction with duloxetine, in such way the obtained analgesic benefit and the better quality of recovery should be merely because of the effect of duloxetine.…”

Effect of single preoperative dose of duloxetine on postoperative analgesia in patients undergoing total abdominal hysterectomy under spinal anesthesia

“…Duloxetine, when used alone as single dose preoperatively, did not have a significant effect on reducing postoperative pain but when combined with dexamethasone had a significant reduction in requirements for rescue analgesia. [ 13 ]…”

New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations

“…Recent research of duloxetine is largely centered on applications as an adjunct therapy in chronic pain management [20][21][22][23]. There is also an expanding role for duloxetine as an adjunct therapy in the acute postoperative period as part of a multimodal analgesia regimen, although results are mixed [24][25][26]. Trials supporting its efficacy are mostly centering on opioid-sparing effects with concurrent therapy [27].…”