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Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials.
- Source :
- Journal of Orthopaedic Surgery & Research; 3/13/2024, Vol. 19 Issue 1, p1-13, 13p
- Publication Year :
- 2024
-
Abstract
- Purpose: There is no consensus in the current literature on the analgesic role of duloxetine after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Thus, we designed this meta-analysis to reveal the analgesic effectiveness and safety of duloxetine in TKA or THA. Methods: As of October 2022, two authors (L.C. and W.Q.J.) independently searched five main databases (EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar) to find relevant studies. Duloxetine vs. placebo in randomized controlled trials (RCTs) for THA or TKA were included. We set perioperative total opioid consumption as the primary outcome. Secondary outcomes included resting or dynamic pain scores over time, gastrointestinal adverse events, neurological adverse events, and other adverse reactions. Results: Eight RCTs with 695 patients were incorporated in our study. This meta-analysis showed high evidence that duloxetine was effective in reducing perioperative opioid consumption (Standard mean difference [SMD] = − 0.50, 95% confidence intervals [CI]: −0.70 to − 0.31, P < 0.00001) and low to moderate evidence that duloxetine could reduce pain within three weeks after surgery. Low to high evidence showed no differences between the two groups for most adverse events. Substantial evidence suggests that duloxetine can reduce nausea and vomiting after surgery (Risk ratio [RR] = 0.69, 95% CI: 0.50 to 0.95, P = 0.02, I<superscript>2</superscript> = 4%). However, moderate evidence suggested that duloxetine might be associated with increased postoperative drowsiness (RR = 1.83, 95% CI: 1.08 to 3.09, P = 0.02, I<superscript>2</superscript> = 0%). Conclusion: Duloxetine reduced overall opioid consumption in the perioperative period and relieved pain within three weeks after surgery without increasing the risk of adverse drug events. Duloxetine can be part of a multimodal management regimen in patients with THA and TKA. [ABSTRACT FROM AUTHOR]
- Subjects :
- MEDICAL information storage & retrieval systems
PAIN measurement
RISK assessment
TOTAL hip replacement
PATIENT safety
DRUG side effects
SURGERY
PATIENTS
POSTOPERATIVE pain
DULOXETINE
META-analysis
DESCRIPTIVE statistics
MEDLINE
TOTAL knee replacement
OPIOID analgesics
DRUG efficacy
MEDICAL databases
PAIN management
ONLINE information services
CONFIDENCE intervals
DRUGS
PERIOPERATIVE care
RELAXATION for health
DRUG utilization
EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 1749799X
- Volume :
- 19
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Journal of Orthopaedic Surgery & Research
- Publication Type :
- Academic Journal
- Accession number :
- 176032536
- Full Text :
- https://doi.org/10.1186/s13018-024-04648-5