Perioperative duloxetine as part of a multimodal analgesia regime reduces postoperative pain in lumbar canal stenosis surgery: a randomized, triple blind, and placebo-controlled trial

Abstract

Background: Duloxetine is an antidepressant that is also useful in chronic neuropathic and central origin pain. In this study, the role of duloxetine in decreasing acute postoperative pain after lumbar canal stenosis surgery is explored. Methods: In this single center, triple blinded, and placebo-controlled trial, 96 patients were randomized for statistical analysis. The intervention group received oral duloxetine 30 mg once a day (OD) for 2 days before surgery, 60 mg OD from the day of surgery to the postoperative second day and 30 mg OD for the next 2 days (a total duration of 7 days). A placebo capsule was given in the other group for a similar time and schedule. The same standard perioperative analgesia protocols were followed in both groups. Results: Total morphine consumption up to 24 hours was significantly decreased in the duloxetine group (P < 0.01). The time to the first analgesia requirement was similar in both groups but the time to the second and third dose of rescue analgesia increased significantly in the duloxetine group. The time to ambulation was decreased significantly (P < 0.01) in the duloxetine group as compared to the placebo group. Pain scores remained similar during most of the time interval. No significant difference was observed in the complication rate and patient satisfaction score recorded. Conclusions: Duloxetine reduces postoperative pain after lumbar canal stenosis surgery with no increase in adverse effects.

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

“…Analgesic drugs can be given through an epidural catheter after surgery, which is a safe and effective method for treating acute postoperative pain 3 . Studies 4,5 have shown that compared with the use of a single drug for postoperative analgesia, multimodal analgesia with different technologies can reduce the dose of opioids and have better analgesic effects. Ropivacaine is an amide‐type local anaesthetic, which has less central nervous system and cardiovascular toxicity, and has better delayed gaps on the sensory and motor nerve block 6 .…”

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

“…Govil et al found total morphine consumption up to 24 h was significantly decreased in the duloxetine group when used for a total duration of 7 days perioperatively. [ 12 ] But in the current study, we have used only a single dose of 60 mg duloxetine preoperatively, duloxetine has a mean plasma half-life of 12 h thus might not have had a significant effect on postoperative pain. 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.…”

“…[ 10 ] There are many studies that have shown preoperative use and continued postoperative use of duloxetine for a few days to weeks has a significant effect on reducing postoperative pain and on reducing analgesic requirements in various surgical patients. [ 8 9 10 11 12 ] There is no literature available on the effect of single preoperative dose of duloxetine on postoperative pain following spinal anesthesia. In the present study, we hypothesized that a single dose of 60 mg duloxetine may reduce postoperative pain in patients undergoing abdominal hysterectomy under spinal anesthesia.…”

Topical agents: a thoughtful choice for multimodal analgesia

“…It is no exaggeration to say that the history of medicine derived from humans trying to reduce pain. In modern times, these efforts to lessen pain are summed up by the term "multimodal analgesia," which refers to a medical practice using diverse systemic medications with various mechanisms of actions [1,2] along with regional/peripheral block techniques [3].…”