Preemptive Duloxetine Relieves Postoperative Pain and Lowers Wound Temperature in Centrally Sensitized Patients Undergoing Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

(1) Background: The purpose of this study was to determine whether preemptive duloxetine in patients with central sensitization (CS) is effective for acute postoperative pain control and wound healing following total knee arthroplasty (TKA). (2) Methods: CS was defined as a score of 40 points or higher on the Central Sensitization Inventory (CSI) survey. Thirty-nine patients with CS were randomly assigned to either the duloxetine group (n = 19) or the placebo group (n = 20). The duloxetine group took duloxetine 30 mg once a day, while the placebo group took the placebo medication once a day. A pain visual analog scale (VAS) and the Brief Pain Inventory (BPI), wound complications, the temperature of the surgical site, and adverse events were investigated. Skin temperature was measured at the center of the patella using a portable digital thermometer. (3) Results: The duloxetine group reported significantly lower pain VAS scores during follow-up periods up to 6 weeks after surgery (all p < 0.05). BPI interference also showed significantly superior results in the duloxetine group after surgery (all p < 0.05). Although there was no difference in the rate of wound complications between the two groups (p > 0.05), the duloxetine group showed significantly lower wound temperature than the placebo group during the follow-up period (all p < 0.05). (4) Conclusion: In this study, preemptive duloxetine effectively reduced pain and lowered wound temperature following TKA in CS patients.

Duloxetine for Postoperative Pain Control Following Knee or Hip Replacement: A Systematic Review and Meta-Analysis

“…Trial success determined based on weather or not the study achieved statistical significance of their registered primary outcome. Study Methodology Intervention Outcomes Registration Surgery Patients per study arm Screening questionnaire Presurgery dosing Postsurgery dosing Primary outcome Statistically Statistically insignificant Significant Secondary outcomes Secondary Outcomes Ho, 2020 [ 21 ] Not registered TKA Duloxetine None 60 mg, 2 h preoperative 60 mg on POD 1 N/A Opioid consumption Pain at all time points; Adverse events (n = 25); placebo (n = 25) YaDeau, 2016 [ 22 ] Methodology consistent with registration TKA Duloxetine(n = 53) None 60 mg, 30 min preoperative 60 mg/d until Failed Opioid consumption NRS-pain length of stay; disposition at discharge; HADS; painDETECT; Knee Society Score; number of manipulations; adverse events Placebo (n = 53) POD 14 Rienstra, 2021 [ 23 ] Methodology consistent with registration THA or TKA Duloxetine (n = 54); No tx (n = 57) m-PDQ 10 wk total: 60 mg for 7 wk; 30 mg for 1 wk dose escalation; 2 wk taper None Failed None KOOS or HOOS; mPDQ Kim, 2021 [ 24 ] Trial ended prematurely TKA Duloxetine(n = 20); placebo (n = 20) CSI 30 mg for 2 wk 8 wk Failed Postoperative opioid use; VAS-pain up to...…”

“…[ 23 ] was atypical in how dosing was tapered in the weeks leading up to surgery. As discussed, preoperative dosing may be an important strategy for decreasing postoperative opioid use [ 24 ].…”

Effect of duloxetine on pain relief after total knee arthroplasty: A meta-analysis of randomized controlled trials

“…6). Data from 3 studies [12,27,29] including 219 patients compared the VAS on postoperative 5 days (MD = −1.05; 95% CI, [−1.75–−0.35]; P < .05. Fig.…”

The efficacy and safety of duloxetine for the treatment of patients after TKA or THA: A systematic review and meta-analysis

“…In addition, the title list was imported into Endnote software, 152 studies which was duplicated or did not meet the inclusion criteria such as reviews, meta-analysis, animal-based studies, case report, and conference papers were excluded. After referring to the full text, 1 retrospective trial and 2 protocols were excluded, and 8 randomized controlled trial (RCT) [11,12,[18][19][20]24,29,30] with 739 patients were finally included. The study selection process and reasons for exclusion are summarized in Figure 1.…”