Preoperative Duloxetine to improve acute pain and quality of recovery in patients undergoing modified radical mastectomy: A dose-ranging randomized controlled trial

Hetta, Diab Fuad; Elgalaly, Nourhan Alaa; Hetta, Helal F; Mohammad, Montaser A. Fattah

doi:10.1016/j.jclinane.2020.110007

Cited by 24 publications

(37 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After tracheal extubation, patients will be transferred to a post-anesthesia care unit (PACU) and receive oxygen supplementation of 3 L/min via a nasal catheter. When a modified Aldrete score ≥9 is reached, patients will be discharged from the PACU to the surgical wards ( 26 ). For antiemetic rescue therapy, an additional dose of ondansetron 4 mg will be administered.…”

Section: Methodsmentioning

confidence: 99%

Opioid-free total intravenous anesthesia for thyroid and parathyroid surgery: Protocol for a randomized, double-blind, controlled trial

et al. 2022

View full text Add to dashboard Cite

BackgroundOpioid-free anesthesia (OFA) may improve postoperative outcomes by reducing opioid-related adverse effects. This study aims to evaluate the effects of OFA on postoperative nausea and vomiting (PONV), postoperative pain, and 30-day outcomes after thyroid and parathyroid surgery.MethodsThis two-center, randomized, double-blind, controlled trial will include 400 adult patients scheduled for thyroid and parathyroid surgery. Patients will be randomly assigned, 1:1 and stratified by sex and site, to an OFA group (esketamine, lidocaine, and dexmedetomidine) or a control group (opioid-based anesthesia with sufentanil). All patients will receive propofol-based total intravenous anesthesia and PONV prophylaxis with dexamethasone and ondansetron. The primary outcome is the incidence of PONV (defined as experiencing any event of nausea, retching, or vomiting) during the first 48 h postoperatively. The secondary outcomes include the severity of PONV, antiemetic rescue therapy, pain scores at rest and while coughing, need for rescue analgesia, perioperative adverse effects related to anesthetics or analgesics (hypotension, bradycardia, hypertension, tachycardia, desaturation, dizziness, headache, hallucination, and nightmare), time to extubation, length of post-anesthesia care unit stay, length of postoperative hospital stay, patient satisfaction, and a composite of 30-day major adverse events (myocardial infarction, cardiac arrest, cerebrovascular accident, coma, acute renal failure, pulmonary embolism, sepsis, septic shock, deep neck space infection, reintubation, reoperation, blood transfusion, failure to wean off ventilator, and death). Analyses will be performed in the modified intention-to-treat population.DiscussionWe hypothesize that our OFA regimen reduces PONV after thyroid and parathyroid surgery. We will also investigate whether OFA leads to improvements in postoperative pain and major adverse events. Our results will offer evidence for optimizing anesthesia regimens in patients who undergo thyroid and parathyroid surgical procedures.Clinical trial registrationhttp://www.chictr.org.cn, identifier: ChiCTR2200059656.

show abstract

Section: Methodsmentioning

confidence: 99%

Opioid-free total intravenous anesthesia for thyroid and parathyroid surgery: Protocol for a randomized, double-blind, controlled trial

et al. 2022

View full text Add to dashboard Cite

show abstract

“…This study employed the use of 60 mg duloxetine, the same dose for treating chronic neuropathic pain. The employed strategy is generally based on analyzing effective duloxetine doses in acute pain ( Hetta et al, 2020 ). Daily doses up to 120 mg were studied; however, higher doses were associated with an increased incidence of side effects without additional benefit ( Schnabel et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

et al. 2022

View full text Add to dashboard Cite

Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties.Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC.Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores.Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups (p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference (p = 0.665) for the time until the patient’s first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals (p = 0.734 and 0.572, respectively).Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC.Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123],

show abstract

“…Amongst 20 trials that administered duloxetine, 15 trials used a fixed daily dose of 60 mg; one used 30 mg daily 45 ; three trials used varied doses of 30e60 mg 34,35,48 ; and one trial compared three doses of 30, 60, and 90 mg with placebo. 50 Placebo was the most common control (23 trials with 25 comparisons), including two four-arm trials that compared placebo with etoricoxib, 40 morphine or pentazocine 29 as baseline treatment. Three trials compared SNRIs with anticonvulsants (including gabapentin 30,46 and pregabalin 42 ), and one four-arm trial compared duloxetine with etoricoxib.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Wang

Tobe

et al. 2022

British Journal of Anaesthesia

View full text Add to dashboard Cite

Preoperative Duloxetine to improve acute pain and quality of recovery in patients undergoing modified radical mastectomy: A dose-ranging randomized controlled trial

Cited by 24 publications

References 24 publications

Opioid-free total intravenous anesthesia for thyroid and parathyroid surgery: Protocol for a randomized, double-blind, controlled trial

Opioid-free total intravenous anesthesia for thyroid and parathyroid surgery: Protocol for a randomized, double-blind, controlled trial

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

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

Contact Info

Product

Resources

About