Duloxetine Acute Postoperative Pain Therapy Supported By Moderate Evidence

Duloxetine acute postoperative pain therapy is supported by low to moderate evidence, according to a review published in Pain Practice. 

Researchers conducted a systematic review and meta-analysis of 29 studies into the use of duloxetine acute postoperative pain therapy. Together, these studies included 2043 participants. 

To find studies for their analysis, the team used the keywords “duloxetine” and “postoperative pain” to search MEDLINE, Web of Science, EMBASE, Google Scholar, and the Cochrane Central Register of Controlled Trials for placebo-controlled randomized clinical trials in which oral duloxetine, 60 mg, was given perioperatively not more than 7 days before surgery, for a least 1 day after surgery, and not more than 14 days after surgery. The team included all such trials that assessed pain efficacy outcomes such as pain scores, opioid consumption, and side effects up to 2 days after surgery.

In their analysis, the team assessed the effects of duloxetine on pain scores, time to first rescue analgesia, consumption of rescue analgesia postoperatively, side effects of the medication, and patient satisfaction. They also analyzed outcomes by subgroup based on type of surgery and patient sex.

To determine effect sizes of duloxetine used for acute postoperative pain therapy, the team calculated standardized mean differences for continuous outcomes, and they determined risk ratios by using the Mantel-Haenszel test for categorical outcomes. To confirm publication bias, they used Egger’s regression test, and if they detected bias or heterogeneity, they used the trim-and-fill method to adjust the effect size.

Using these methods, the team determined that postoperative pain scores and opioid consumption by 24 hours and 48 hours after surgery were both lower with duloxetine than with placebo, and time to first rescue analgesia was greater for duloxetine than for placebo (P <.05 for all comparisons).

Despite these benefits, researchers also explain that “There is no significant improvement in the quality of the recovery score QOR-40 score and patient satisfaction in patients who were given duloxetine.”

 “Future trials of duloxetine for pain relief for acute pain after surgery must also focus on the optimal duration of preoperative doses by dose titration and their interaction with the anesthetic drugs to get the best patient-centric outcome,” according to the study authors.

Limitations of the analysis included lack of analysis of the effects of duloxetine treatment for more than 14 days and lack of assessment of outcomes for subacute or chronic pain. The researchers also cautioned that their results may not hold true for all types of surgery or for patients in all age groups and that most of the studies they analyzed did not assess pain during movement or coughing.