Perioperative Duloxetine for Pain Management After Laparoscopic Hysterectomy: A Randomized Placebo-Controlled Trial

Abstract

To evaluate the effect of perioperative duloxetine on pain management in patients recovering from laparoscopic hysterectomy. Design: A randomized placebo-controlled trial. Setting: A university hospital. Patients: Of 100 patients enrolled, 80 were randomized 1:1 to receive perioperative duloxetine (n = 40) or placebo (n = 40). Interventions: Patients undergoing laparoscopic hysterectomy for benign conditions from November 2017 through March 2018 received 2 doses of 60 mg duloxetine or placebo 2 hours before and 24 hours after surgery. Measurements and Main Results: The Quality of Recovery (QoR)-40 questionnaire was completed by participants after discharge. Study and control groups were compared in terms of questionnaire scores, opioid analgesic use, and hospital length of stay. The baseline characteristics of the groups were comparable; median total QoR-40 scores were 111 of 200 and 112 of 200 for duloxetine and the placebo group, respectively; the difference did not reach statistical significance (p = .91). Although the physical independence subcomponent of the recovery questionnaire was improved in favor of duloxetine, none of the subcomponents reached statistical difference between groups. The groups did not differ in terms of postoperative narcotic analgesic use and hospital length of stay (p >.05). Conclusion: Perioperative duloxetine did not reduce pain, need for narcotic analgesia, or hospital length of stay following laparoscopic hysterectomy.

Effect of Preoperative Duloxetine on Opioid Consumption in Women Undergoing Abdominal Hysterectomy: A Randomized, Double-Blinded, Placebo-Controlled Trial

“…There was also no difference in physical discomfort, including nausea and vomiting. This was the same in the two groups (10). Although the method of surgery was different from what we studied, the findings were in agreement with ours.…”

“…Takmaz et al (10) randomly assigned 80 women who were candidates for laparoscopic hysterectomy into two groups. Group 1 received duloxetine, and group 2 received a placebo.…”

“…Duloxetine is used for the management of postoperative pain. It inhibits serotonin and norepinephrine reuptake in the CNS, which results in pain pathway alteration (10). It also modulates emotional status during the perioperative period and may reduce the need for opioid consumption (15).…”

“…Duloxetine is a serotonin-norepinephrine reuptake in-hibitor (SNRI) that is used for treating major depression, anxiety, and chronic pain (7,8). As it can help regulate emotions and has perioperative analgesic effects, some studies regard it as a beneficial medication to be taken following a hysterectomy (9,10). Some studies suggested that further research is needed to determine the effectiveness of duloxetine and its optimal dose for the management of acute postoperative pain (11,12).…”

Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors as adjuncts for postoperative pain management: systematic review and meta-analysis of randomised controlled trials

“…29,30,32e36,38,39,45,48 Most trials (17 of 24; 71%) used general anaesthesia, five (21%) used local or regional anaesthesia, and two studies (8%) allowed the use of either general or regional anaesthesia. 31,36 Background analgesia included acetaminophen alone, 33,40,49,51 or in combination with NSAIDs (celecoxib 36 or metamizole 52 ), opioids (codeine, 30,34 tramadol, 38,42,45,48 fentanyl, 48,50 or oxycodone 45 ), or both, 31,39 and NSAIDs 37,41,43,47 or opioids (morphine or pentazocine) 29 alone. Four trials 32,35,44,46 did not report baseline analgesia.…”