Significant Analgesic Benefits of Perioperative Duloxetine in Patients Who Have Depressive Symptoms Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial

Ding, Zichuan; Li, Hao; Huang, Chao; Yuan, Min; Cao, Jian; Wang, Haoyang; Zhou, Kai

doi:10.1016/j.arth.2022.10.007

Cited by 7 publications

(11 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to screening the title and abstract, 18 articles were included in this study. Finally, 8 full-text publications passed the first screening and were ultimately analyzed [ 19 – 22 , 26 – 29 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials

Lin,

Jiang,

Liao

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

Purpose There is no consensus in the current literature on the analgesic role of duloxetine after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Thus, we designed this meta-analysis to reveal the analgesic effectiveness and safety of duloxetine in TKA or THA. Methods As of October 2022, two authors (L.C. and W.Q.J.) independently searched five main databases (EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar) to find relevant studies. Duloxetine vs. placebo in randomized controlled trials (RCTs) for THA or TKA were included. We set perioperative total opioid consumption as the primary outcome. Secondary outcomes included resting or dynamic pain scores over time, gastrointestinal adverse events, neurological adverse events, and other adverse reactions. Results Eight RCTs with 695 patients were incorporated in our study. This meta-analysis showed high evidence that duloxetine was effective in reducing perioperative opioid consumption (Standard mean difference [SMD] = − 0.50, 95% confidence intervals [CI]: −0.70 to − 0.31, P < 0.00001) and low to moderate evidence that duloxetine could reduce pain within three weeks after surgery. Low to high evidence showed no differences between the two groups for most adverse events. Substantial evidence suggests that duloxetine can reduce nausea and vomiting after surgery (Risk ratio [RR] = 0.69, 95% CI: 0.50 to 0.95, P = 0.02, I2 = 4%). However, moderate evidence suggested that duloxetine might be associated with increased postoperative drowsiness (RR = 1.83, 95% CI: 1.08 to 3.09, P = 0.02, I2 = 0%). Conclusion Duloxetine reduced overall opioid consumption in the perioperative period and relieved pain within three weeks after surgery without increasing the risk of adverse drug events. Duloxetine can be part of a multimodal management regimen in patients with THA and TKA.

show abstract

Section: Resultsmentioning

confidence: 99%

“…The sample size of the included studies ranged from 39 to 160, with a distribution of 347 in the duloxetine group and 348 in the control group. Regarding the surgical type, 6 involved TKA [ 19 , 20 , 22 , 27 – 29 ], and 2 involved THA [ 21 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials

Lin,

Jiang,

Liao

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…No notable differences were noted in any outcomes at 12 weeks. 27 Yilmaz et al evaluated the effect of alprazolam and found that patients receiving this medication had markedly lower analgesic requirements postoperatively and a markedly greater magnitude of change in functional scores. 25…”

Section: Resultsmentioning

confidence: 99%

Treatment of Concurrent Depression and Its Effect on Outcomes After Total Joint Arthroplasty: A Systematic Review of Comparative Studies

Morgan,

Shahabi,

Kruse

et al. 2023

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Purpose: There is a growing body of evidence suggesting that patients with a diagnosis of depression suffer worse outcomes after total joint arthroplasty (TJA) procedures. It is unclear whether depression treatment is a modifiable risk factor that can be targeted to improve suboptimal outcomes. We conducted a systematic review to understand the role that various interventions have on outcomes of TJA in patients with diagnosed depression (PDDs). Methods: PubMed, Ovid MEDLINE, Scopus, and EMBASE were searched systematically from inception until November 2022. Studies of PDDs who underwent TJA that compared any intervention/treatment of depression with a control group and reported pain, functional outcomes, depression scores, and/or revision rates after TJA were relevant for this review. Results: Ten relevant studies were included in the final systematic review, with a total of 33,501 patients included. Two studies reported lower revision rates for patients receiving selective serotonin reuptake inhibitor treatment and psychotherapy. Two studies showed no difference in functional outcomes for patients receiving pharmacologic treatment. One study reported improved functional outcomes for patients receiving cognitive behavioral therapy and another reported improved postoperative functional outcomes for patients receiving alprazolam. Conclusion: Interventions targeted at PDDs may improve short-term pain and functional outcomes, and there may be an association between selective serotonin reuptake inhibitor use and implant survival. The current literature is limited and inconclusive, with important gaps in understanding regarding the optimization and treatment of this modifiable risk factor. Surgeons should consider depression treatment as a method to improve outcomes in this cohort.

show abstract

“…Patients with urine volumes less than 400 ml had repeated assessment in 2 hours. All participants accepted the same perioperative multimodal analgesic protocol as previous reported ( Ding et al, 2022a ).…”

Section: Methodsmentioning

confidence: 99%

Prophylactic doxazosin reduces urinary retention and promotes recovery after total joint arthroplasty: A randomized controlled trial

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background: Postoperative urinary retention (POUR) is a common and disruptive complication following total joint arthroplasty (TJA). The aim of this study is to investigate whether doxazosin can decrease the incidence of POUR and promote recovery under the setting of modern enhanced recovery after TJA.Methods: In this randomized placebo-controlled trial, patients over 35 years of age undergoing primary unilateral TJA were recruited. Patients received doxazosin (4 mg once) or placebo 2 h before surgery. The primary outcome of interest was the development of POUR, which was diagnosed when patients with a urine volume over 400 ml or overflow incontinence. Postoperative recovery was assessed in terms of hospital length of stay after surgery, daily ambulation distance, visual analogue scale (VAS) pain score and opioid consumption.Results: A total of 170 male patients were equally randomized into Doxazosin group (mean age 54.2 ± 13.7 years, range 36–88 years) and Placebo group (mean age 54.6 ± 13.9 years, range 38–81 years). The POUR rate was significant lower in Doxazosin group (17.6%) than in Placebo group (36.5%) (p = .006). The mean LOS in the Doxazosin group was 3.1 ± 1.1 days compared to 3.6 ± 1.7 days in the Placebo group (p = .030). Doxazosin group had a longer daily mobilization distance than Placebo group on postoperative day 1 (26.8 ± 11.1 vs. 22.8 ± 9.7; p = .015). Postoperative pain assessed by VAS score and opioid usage was comparable between two groups.Conclusion: Our results support the routine use of prophylactic doxazosin in male patients to decrease POUR rate and promote postoperative recovery under the setting of modern enhanced recovery after TJA.

show abstract

Significant Analgesic Benefits of Perioperative Duloxetine in Patients Who Have Depressive Symptoms Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial

Cited by 7 publications

References 36 publications

Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials

Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials

Treatment of Concurrent Depression and Its Effect on Outcomes After Total Joint Arthroplasty: A Systematic Review of Comparative Studies

Prophylactic doxazosin reduces urinary retention and promotes recovery after total joint arthroplasty: A randomized controlled trial

Contact Info

Product

Resources

About