Medicines and Opioids Consumption Effect on Post-operative Pain

Postoperative pain is influenced by various factors, including the duration and site of the operation, the amount of manipulation involved, and the individualized perception of pain. More than two-thirds of patients who undergo total joint arthroplasty experience severe postoperative pain. Many patients suffer from extreme pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA), especially in the first 2 weeks. Enhanced pain control after arthroplasty is related to shorter rehabilitation time, decreased complications, and improved patient satisfaction. The number of joint arthroplasty surgeries have increased worldwide, with more than one million arthroplasties performed each year in the United States. Considering the increased number of arthroplasty cases, it seems necessary to identify the latest approaches for postoperative pain control. Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SNRI), has been approved for treating depression,

anxiety, and post-traumatic stress disorders by the US Food and Drug Administration (FDA). It has also been

approved to treat diabetic neuropathic pain and fibromyalgia. Several studies has shown the role of duloxetine in reducing the pain caused by knee and hip osteoarthritis, two systematic reviews and meta-analyses have confirmed duloxetine’s analgesic and opioid-sparing role postoperatively. In conclusion, Duloxetine 30mg/60mg shows moderate opioid sparing effects and statistically significant reduction in pain scores with no significant difference in the prevalence of side effects versus Placebo.

 

Reference:
Azimi A, Hooshmand E, Mafi AA, Tabatabaei F-S. Effect of duloxetine on opioid consumption and pain after total knee and hip arthroplasty: A systematic review and meta-analysis of randomized clinical trials. Pain Medicine. 2023;24(9):1035–45. doi:10.1093/pm/pnad045