Preoperative duloxetine on postoperative pain after laparoscopic gynecological surgeries: A systematic review and meta-analysis of randomized controlled trials

Baradwan, Saeed; Alshahrani, Majed Saeed; Alkhamis, Waleed H.; Allam, Hassan; AlSghan, Rayan; Ghazi, Ahmed; Ragab, Bassem; Elmazzaly, Saged; Aboshama, Rehab Abdelhamid; Ismail, Reda A.; Dahshan, Shaimaa A.; Al-Touny, Aiman A.; Daghash, Noha Hassan; Abdelhakim, Ahmed Mohamed; Abbas, Ahmed M.; Fouda, Albayoumi A.; Abdelfattah, Laila Ezzat

doi:10.1016/j.jogoh.2021.102305

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…Also, Attia & Mansour, [6] reported that there were no significant differences in the incidence complications between the two groups in lumbar Laminectomy surgery. As well, Baradwan et al, [15] revealed that both groups didn't vary in side effects and the length of hospital stay after laparoscopic gynecological surgeries. However, Mantay et al, [13] revealed that the incidence of nausea and insomnia where comparable between groups, but dizziness and dry mouth were significantly more in duloxetine group compared to controls.…”

Section: ~ 23 ~mentioning

confidence: 89%

“…The study found that the median (interquartile range) amount of morphine consumed in the initial 24 hours after surgery was substantially reduced in the D60 and D90 groups contrasted to the control and D30 groups. In addition, Baradwan et al [15] conducted a systematic review and meta-analysis to assess the effectiveness and safety of preoperative duloxetine in managing postoperative pain following gynaecologic laparoscopic procedures. The meta-analysis included a total of 244 individuals, with 123 of them in the duloxetine group and 121 individuals in the placebo group.…”

Section: Discussionmentioning

confidence: 99%

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Duloxetine for post-operative analgesia after modified radical mastectomy: A prospective randomized study

Elfeky,

Alzeftawy,

Ghafar

et al. 2023

Int. J. Med. Anesthesiology

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Background: Insufficient management of postoperative pain has been shown to be correlated with prolonged hospitalization, escalated healthcare expenses, disrupted sleep patterns, heightened risk of depression, compromised functional abilities, and a worse quality of life. The objective of this research is to assess the efficacy of duloxetine in managing postoperative pain following radical mastectomy. Methods: This prospective randomised controlled work was performed on (40) individuals scheduled for modified radical mastectomy in Tanta University Hospital. The criteria for inclusion for this study consisted of adult female patients between the ages of 18 and 60 who were scheduled to have a modified radical mastectomy (MRM), ASA I, II and III. A total of 20 participants were recruited for this research, with an equal number of participants being randomly assigned to each of the two groups. The process of randomization was conducted using a computer-generated method. The patients were allocated by closed envelop into 2 groups: Group (1) (control group): Participants received 500 mg of IV acetaminophen (every 6 hours post operatively). Group (2): Participants received duloxetine 30 mg every 12 h for 3 days prior to operation, 30 mg 2 h prior to surgery and 30 mg 12 h following surgery and 500 mg of IV acetaminophen (every 6 hours following surgery). Results: There was significant decrease at 2,4,6,18,30,36 and 48 h in group 2 contrasted to group 1 (P value <0.001) and statistically insignificant difference in postoperative HR at baseline, PACU, 12, 24 and 42 h among both groups. A substantial decrease in postoperative MAP was existed at 2,4,6,18,30,36 and 48 h in group 2 contrasted to group 1 and statistically insignificant difference at baseline, PACU, 12, 24 and 42 h among both groups (P value <0.001). A statistically substantial decrease in intraoperative fentanyl consumption was existed in group 2 compared to groups 1 (P value <0.001). There was substantial decrease in VAS at 2,4,6,18,30,36 and 48 hours in group 2 contrasted to group 1 (P value<0.05). The satisfied patients in group 2 were significantly higher in group 2 compared to group 1. Conclusions: The current work showed that the use of perioperative duloxetine was safe and effective in controlling pain after modified radical mastectomy.

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Section: ~ 23 ~mentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Duloxetine for post-operative analgesia after modified radical mastectomy: A prospective randomized study

Elfeky,

Alzeftawy,

Ghafar

et al. 2023

Int. J. Med. Anesthesiology

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“…Wang et al worked on the limitations of Schnabel et al and concluded that SNRI probably provides a slight reduction in postoperative pain without increasing adverse effects. Baradwan et al conducted a meta‐analysis of 4 RCTs with 244 patients undergoing laparoscopic gynecological procedures and found duloxetine to be safe and effective for pain management in these surgical cohorts 60 …”

Section: Discussionmentioning

confidence: 99%

“…Previous reviews on duloxetine by Branton et al (included 5 RCTs and 314 patients), 7 Zorilla-Vaca (included 9 RCTs and 574 patients) 5 patients undergoing laparoscopic gynecological procedures and found duloxetine to be safe and effective for pain management in these surgical cohorts. 60 Wang et al found a moderate level of evidence in favor of duloxetine as pain scores significantly decreased in 1 month (7 studies; 814 patients weighted mean difference (WMD) −0.71 cm [−1.11 to −0.31]), 3 months (5 studies; 608 patients −0.64 cm [−1.05 to −0.22]), and 6 months (3 studies; 508 patients −0.95 cm [−1.64 to −0.25]). 9 We have not focused on the long-term effects of perioperative duloxetine beyond 48 h as it is unlikely that one or two doses used in most of the studies have any potential long-term effects.…”

Section: Discussionmentioning

confidence: 99%

Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta‐analysis of randomized clinical trials

Govil¹,

Arora²,

Parag³

et al. 2023

Pain Practice

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BackgroundDuloxetine has been used as an adjunct in multimodal analgesia for acute postoperative pain in clinical studies. This meta‐analysis aims to conclude whether oral duloxetine, when given perioperatively, is any better than a placebo in managing postoperative pain. Effects of duloxetine on postoperative pain scores, time to first rescue analgesia, postoperative rescue analgesia consumption, side effects attributable to duloxetine, and patient satisfaction profile were assessed.MethodMEDLINE, Web of Science, EMBASE, Scholar Google, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched with keywords including “Duloxetine” AND “postoperative pain”, “Duloxetine” AND “acute pain” and with “Duloxetine” till October 2022. This meta‐analysis included randomized clinical trials in which perioperative duloxetine 60 mg per oral was administered not more than 7 days before surgery and for at least 24 after surgery but not more than 14 days after surgery. All RCTs in which the comparator is placebo and outcomes related to analgesic efficacy like pain scores, opioid consumption, and side effects of duloxetine until 48 h postoperatively were included. Data were extracted from the studies and a risk of bias summary was formed using the Cochrane Collaboration tool. Effect sizes were given as standardized mean differences for continuous outcomes and risk ratios (RR) by the Mantel–Haenszel test for the categorical outcome. Confirmation of publication bias was done by Egger's regression test (p < 0.05). If publication bias or heterogeneity was detected, the trim‐and‐fill method was used to calculate the adjusted effect size. Sensitivity analysis was done by leaving one out method after excluding the study with a high risk of bias. Subgroup analysis was done based on the type of surgery and gender. The study was prospectively registered in the PROSPERO under the registration number CRD42019139559.Findings29 studies with 2043 patients met the inclusion criteria and were reviewed for this meta‐analysis. Postoperative pain scores at 24 h [Std. Mean Difference (95% CI); −0.69 (−1.07, −0.32)] and at 48 h [−1.13 (−1.68, −0.58)] are significantly less with duloxetine (p‐value < 0.05). Time to first rescue analgesia was significantly more in patients where duloxetine was administered [1.27 (1.10, 1.45); p‐value > 0.05]. Opioid consumption up to 24 h [−1.82 (−2.46, −1.18)] and 48 h [−2.48 (−3.46, −1.50)] was significantly less (p‐value < 0.05) in patients who received duloxetine. Complications and recovery profiles were similar in patients receiving either duloxetine or a placebo.InterpretationBased on GRADE findings, we conclude that there is low to moderate evidence to advocate the use of duloxetine for managing postoperative pain. Further trials are needed to replicate or refute these results based on robust methodology.

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“…The safety and efficacy of duloxetine premedication were attested earlier by Baradwan et al . [ 28 ] Their systematic review and meta-analysis included four RCTs and 244 patients undergoing laparoscopic gynaecological surgeries. The authors concluded that duloxetine premedication is a safe and effective medication with minimal adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy and safety of duloxetine premedication in patients undergoing hysterectomy – A systematic review

Nair,

Thakre,

Rangaiah

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Patients undergoing hysterectomy by open or laparoscopic approach experience moderate to severe postoperative pain. A multimodal analgesic approach is recommended for these patients. This study reviews the analgesic efficacy of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor used as an adjuvant for opioid-sparing postoperative analgesia. Methods: After registering the protocol in the international prospective register of systematic reviews (PROSPERO), databases like PubMed, Ovid, Scopus, Cochrane Library and clinicaltrials.gov were searched for randomised controlled trials using relevant keywords to find studies in which duloxetine premedication was compared to a placebo in patients undergoing hysterectomy. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of evidence. Results: The qualitative systematic review included five of the 88 studies identified. The overall risk of bias in the included studies was very high. In all the studies, 60 mg oral duloxetine was used, and the control group was placebo. In two studies, duloxetine premedication was administered 2 h before and 24 h after surgery. In the other three studies, a single dose of 60 mg duloxetine was only administered 2 h before surgery. A pooled meta-analysis was not performed due to fewer studies that fulfilled the inclusion criteria and even fewer studies with consistent reporting of various outcomes. Conclusion: The evidence is insufficient to advocate routine duloxetine premedication in patients undergoing hysterectomy.

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Preoperative duloxetine on postoperative pain after laparoscopic gynecological surgeries: A systematic review and meta-analysis of randomized controlled trials

Cited by 6 publications

References 21 publications

Duloxetine for post-operative analgesia after modified radical mastectomy: A prospective randomized study

Duloxetine for post-operative analgesia after modified radical mastectomy: A prospective randomized study

Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta‐analysis of randomized clinical trials

Analgesic efficacy and safety of duloxetine premedication in patients undergoing hysterectomy – A systematic review

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