The use of duloxetine reduced postoperative pain and opioid consumption among patients who underwent total joint arthroplasty (TJA), according to a systematic review and meta-analysis published in the journal Arthroplasty Today.
Researchers from University of Washington and Keck School of Medicine searched publication databases for studies using duloxetine for pain management after total knee or hip arthroplasty. A total of 8 reports published between 2016 and 2022 were included in this analysis.
The studies included between 20 and 80 participants in the duloxetine and control study groups. Duloxetine was administered at 30 or 60 mg and 7 trials started duloxetine treatment prior to surgery. In 5 studies, the control condition was no treatment and in 3, it was placebo.
At baseline, Visual Analogue Scale (VAS) scores for pain at rest or movement did not differ between the duloxetine and comparator cohorts. At post operative days 3 (weighted mean difference [WMD], -0.52; 95% CI, -0.83 to -0.22 points; P =.001) and 7 (WMD, -0.80; 95% CI, -1.38 to -0.22 points; P =.007) and week 6 (WMD, -2.01; 95% CI, -2.41 to -1.61 points; P <.001).
VAS scores at rest were significantly lower among duloxetine recipients compared with control individuals. Similarly, duloxetine was associated with lower VAS pain scores on movement at days 1, 3, 7, and 14 (WMD range, -1.02 to -0.56 to points; all P £.016), week 6 (WMD, -1.41; 95% CI, -1.79 to -1.02; P <.001), and month 3 (WMD, -0.80; 95% CI, -1.56 to -0.04; P =.038) compared with control individuals.
At 24 hours post-TJA, the duloxetine recipients consumed similar amounts of opioids as placebo or no treatment recipients (WMD, -2.64; 95% CI, -11.81 to 6.53; P =.573). At 48 (WMD, -11.98; 95% CI, -21.32 to -2.65; P =.012) and 72 (WMD, -10.73; 95% CI, -21.37 to -0.09; P =.048) hours, however, the duloxetine group consumed fewer opioids than the comparator groups.
Among the 307 patients who received duloxetine, no significant adverse events were reported.
In the qualitative review of the data, the researchers noted a high degree of heterogeneity and a variable amount of success.
The limitations of this analysis included the small number of eligible studies and their sample sizes.
The researchers highlighted that “[D]uloxetine appears to safely decrease postoperative pain and opioid consumption following TJA.”
“While there is a need for follow-up studies to determine the optimal dose, duration, and patient population, strong preliminary data provide robust support for future large-scale efficacy studies,” they concluded.
Jones IA, Talehakimi A, Murphy LS, et al. Duloxetine for postoperative pain control following knee or hip replacement: a systematic review and meta-analysis. Arthroplast Today. February 14, 2023. doi:10.1016/j.artd.2023.101097