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BACKGROUND AND OBJECTIVE: Postoperative pain management is considered as a part of recovery. Duloxetine (DLX), an anti-depressant medication, is a possible choice for the multimodal anesthetic strategy. We aimed to evaluate the effect of Duloxetine on postoperative hysterectomy pain management in patients who underwent hysterectomy. METHODS: In this randomized double-blind clinical trial, 60 patients aged 18-85 years with ASA I and II who were candidates for hysterectomy were randomly assigned to two group of 30 patients taking duloxetine (60 mg capsule) or placebo (starch). Opioid use, postoperative pain due to visual analogue score, vital signs and quality of recovery (Recovery-40 form), vital signs before induction of anesthesia, immediately after surgery, at isoflurane induction and after surgery every 15 minutes were reviewed and compared in two groups. FINDINGS: The amount of opioids in the duloxetine group decreased insignificantly. Postoperative pain in recovery and ward in duloxetine group (2.7±0.99 and 1.8±0.66, respectively) compared to placebo group (4.86±1.51 and 4.86±1.51, respectively) decreased significantly (p= 0.006 in recovery and p= 0.001 in ward). The quality of improvement in recovery (156.22±24.25 in the duloxetine group and 125.48±16.49 in the placebo group) was in favor of the effectiveness of duloxetine (p= 0.001). CONCLUSION: In conclusion, DLX is a beneficial drug to be used in multimodal anesthesia strategy especially in improving postoperative pain and quality of recovery in abdominal hysterectomy.

Background: Peripheral neuropathic pain is a common disorder in patients with diabetes mellitus, which causes significant disability. Various treatments for this disorder have been proposed. This study aimed to find the best medicine for treating these patients (in short-term pain relief) via a comparison between duloxetine, venlafaxine, and pregabalin. Methods: 115 patients with diabetic polyneuropathy participated in this study. Patients were randomly divided into three groups of duloxetine (60 mg daily), venlafaxine (37.5 mg daily), and pregabalin (300 mg daily). At the end of the sixth weeks, pain severity and duration (hours per day) were evaluated and compared in three groups. Findings: The severity of pain after 6 weeks of treatment in the duloxetine group was significantly lower than the other groups (P = 0.030). However, the mean difference in pain intensity in the three groups was reduced, but there was no statistically significant difference (P = 0.174). Regarding the duration of pain, it was found that after the treatment, the duration of pain was not significantly different between the groups (P < 0.050). Conclusion: There was no difference in the results of treatment with duloxetine, venlafaxine, and pregabalin in reducing pain in patients with diabetic polyneuropathy. Therefore, one of the drugs can be prescribed according to the conditions of the patient.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common and mostly chronic mental health condition that affects children, adolescents, and adults. Stimulants and atomoxetine are first-line agents for the treatment of ADHD. Despite the impressive track record of stimulants in the treatment of ADHD, they fail in 25% of patients due to lack of efficacy or the emergence of unwanted side effects. Accordingly, this study carried out to compare efficacy and safety of duloxetine (a serotonin and norepinephrine reuptake inhibitor) and methylphenidate (a short acting stimulant) in the treatment of children with attention-deficit/hyperactivity disorder. Methods: Twenty-four children diagnosed with ADHD participated in this 6 weeks open clinical trial. Patients were between 6 to 11 years old that had been referred to psychiatry clinic at Akhavan and Rofide Medical and Rehabilitation Center in Tehran from September 2012 to July 2014. Diagnosis was made by two child psychiatrist according to DSM-IV TR criteria. Thirteen patients received duloxetine and others received methylphenidate. Conner’ parent rating scale-revised-short form (CPRS-RS) and ADHD-rating scale (ADHD-RS) were used at the beginning and then each two weeks to assess efficacy of treatment. Routine laboratory tests and electrocardiogram (ECG) was carried out in the beginning and end of the trial. Results: Twenty children with ADHD completed the study (Ten in methylphenidate and ten in duloxetine group). In both groups, scales of CPRS-RS and ADHD-RS were reduced from baseline to endpoint, but this reduction in methylphenidate group was significantly greater than duloxetine group (P= 0.000). The most common side effect was gastrointestinal problems in duloxetine group and anorexia in methylphenidate group. No serious side effects and no changes in laboratory and ECG indexes were seen in both groups. Conclusion: Duloxetine is not efficacious as well as methylphenidate in treatment of children with ADHD. Although more research are needed to achieve more accurate results.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common and mostly chronic mental health condition that affects children, adolescents, and adults. Stimulants and atomoxetine are first-line agents for the treatment of ADHD. Despite the impressive track record of stimulants in the treatment of ADHD, they fail in 25% of patients due to lack of efficacy or the emergence of unwanted side effects. Accordingly, this study carried out to compare efficacy and safety of duloxetine (a serotonin and norepinephrine reuptake inhibitor) and methylphenidate (a short acting stimulant) in the treatment of children with attention-deficit/hyperactivity disorder. Methods: Twenty-four children diagnosed with ADHD participated in this 6 weeks open clinical trial. Patients were between 6 to 11 years old that had been referred to psychiatry clinic at Akhavan and Rofide Medical and Rehabilitation Center in Tehran from September 2012 to July 2014. Diagnosis was made by two child psychiatrist according to DSM-IV TR criteria. Thirteen patients received duloxetine and others received methylphenidate. Conner' parent rating scale-revised-short form (CPRS-RS) and ADHD-rating scale (ADHD-RS) were used at the beginning and then each two weeks to assess efficacy of treatment. Routine laboratory tests and electrocardiogram (ECG) was carried out in the beginning and end of the trial. Results: Twenty children with ADHD completed the study (Ten in methylphenidate and ten in duloxetine group). In both groups, scales of CPRS-RS and ADHD-RS were reduced from baseline to endpoint, but this reduction in methylphenidate group was significantly greater than duloxetine group (P= 0.000). The most common side effect was gastrointestinal problems in duloxetine group and anorexia in methylphenidate group. No serious side effects and no changes in laboratory and ECG indexes were seen in both groups. Conclusion: Duloxetine is not efficacious as well as methylphenidate in treatment of children with ADHD. Although more research are needed to achieve more accurate results. [ABSTRACT FROM AUTHOR]