Does postoperative low-dose duloxetine provide analgesic effect and lower morphine consumption after primary total knee arthroplasty? A prospective, double-blind, randomized controlled trial.

Autor: Pinsornsak P; Department of Orthopaedic Surgery, Thammasat University, Pathum Thani, Thailand., Phunphakchit J; Department of Orthopaedic Surgery, Thammasat University, Pathum Thani, Thailand., Pinsornsak P; Kasetsart University Laboratory School Center for Educational Research and Development, Bangkok, Thailand., Boontanapibul K; Department of Orthopaedic Surgery, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand. krit.boontanapibul@gmail.com.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Nov; Vol. 144 (11), pp. 4979-4987. Date of Electronic Publication: 2024 Sep 30.
DOI: 10.1007/s00402-024-05591-0
Abstrakt: Introduction: Duloxetine as an adjunct analgesic has shown effective results in trials of patients undergoing total knee arthroplasty (TKA). However, the regimen has not been standardized. We, therefore, evaluated the analgesic efficacy of low-dose duloxetine after TKA.
Materials and Methods: We conducted a double-blind, randomized controlled trial of patients undergoing unilateral primary TKA, comparing 30 mg/d of duloxetine for 6 weeks as an additive medication for pain control to modern multimodal analgesia after TKA. The primary outcome measure was a visual analogue scale (VAS) for pain at rest, during walking, and at night at 24 h, 72 h, 2 weeks, 6 weeks, and 12 weeks after the operation. Secondary outcomes were morphine consumption, adverse events, and functional outcomes: Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score (KOOS).
Results: Mean VAS for pain at rest, during walking, and at night at 24 h, 72 h, 2 weeks, 6 weeks, and 12 weeks showed no significant differences between the two groups, except a significantly lower mean VAS at night at 2 weeks in the duloxetine group. Mean total morphine consumption (0-72 h) was 33% less in the duloxetine group (6.8 ± 5.7 vs. 10.2 ± 7.3 mg, p = 0.04). There were no significant differences in adverse events and functional outcomes except better KOOS symptoms at 6 and 12 weeks in the duloxetine group.
Conclusion: Low-dose duloxetine could reduce postoperative morphine consumption and improve KOOS symptoms at 6 and 12 weeks with good tolerability. However, it did not significantly reduce pain at rest or during walking. Low-dose duloxetine can be considered an addition to contemporary multimodal pain management after TKA.
Level of Evidence V: Therapeutic Level I.
Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical aprroval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the human research ethics committee of Thammasat University (May 15, 2020/ MTU-EC-OT-0-130/64). Consent for publication: The authors affirm that human research participants provided informed consent for publication. Consent to participate: Informed consent was obtained from all participants.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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