Duloxetine for Postoperative Pain in Orthopedic Surgeries: A Review Article
Abstract
Postoperative pain plays a key role in patients’ satisfaction. Since opioids may cause dependence and have a high abuse rate, non- opioid drugs such as duloxetine are being investigated for their effect in this matter. This review investigated the pharmacokinetics and the effects of duloxetine on postoperative pain after orthopedic surgeries. Duloxetine is a dual serotonin and norepinephrine reuptake inhibitor that causes a synergistic effect and can help manage postoperative pain. For this cause, it is prescribed as 60 mg per day. There have been studies in recent years proving its effectiveness both in total hip and knee arthroplasties and elective surgeries. The collective data show that duloxetine can be used for postoperative pain management, and with minimal side effects, it can lower opioid usage and dependence. However, considering duloxetine side effects including gastrointestinal (GI) disturbances (nausea, constipation), dry mouth, and loss of appetite, and the limitations of current literature, further studies need to be conducted.
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2. Eckhard L, Jones T, Collins JE, Shrestha S, Fitz W. Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(7):2167-72. doi: 10.1007/s00167-019- 05449-8. [PubMed: 30826856].
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6. Noshahr RM, Kouhestani E, Dibamehr M, Alshohaib M. The effect of duloxetine on postoperative pain and opium consumption in spine surgery: A systematic review. N Am Spine Soc J. 2024;17:100303. doi: 10.1016/j.xnsj.2023.100303. [PubMed: 38235484]. [PubMed Central: PMC10793159].
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8. Briley M, Moret C. Treatment of comorbid pain with serotonin norepinephrine reuptake inhibitors. CNS Spectr . 2008;13(7 Suppl 11):22-6. doi: 10.1017/s1092852900028285. [PubMed: 18622371].
9. Rosenberg MB, Carroll FI, Negus SS. Effects of monoamine reuptake inhibitors in assays of acute pain-stimulated and pain-depressed behavior in rats. J Pain. 2013;14(3):246-59. doi: 10.1016/j.jpain.2012.11.006. [PubMed: 23332494]. [PubMed Central: PMC3743421].
10. Jost W, Marsalek P. Duloxetine: mechanism of action at the lower urinary tract and Onuf's nucleus. Clin Auton Res. 2004;14(4):220-7. doi: 10.1007/s10286-004-0197-8. [PubMed: 15316838].
11. Pergolizzi JV, Raffa RB, Taylor, Rodriguez G, Nalamachu S, Langley P. A review of duloxetine 60 mg once-daily dosing for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain. Pain Pract. 2013;13(3): 239-52. doi: 10.1111/j.1533-2500.2012.00578.x. [PubMed: 22716295].
12. Wernicke JF, Gahimer J, Yalcin I, Wulster-Radcliffe M, Viktrup L. Safety and adverse event profile of duloxetine. Expert Opin Drug Saf. 2005;4(6):987-93. doi: 10.1517/14740338.4.6.987. [PubMed: 16255658].
13. Polychroniou PE, Mayberg HS, Craighead WE, Rakofsky JJ, Aponte R, V, Haroon E, et al. Temporal profiles and dose- responsiveness of side effects with escitalopram and duloxetine in treatment-naive depressed adults. Behav Sci (Basel). 2018;8(7). doi: 10.3390/bs8070064. [PubMed: 30018196]. [PubMed Central: PMC6071033].
14. YaDeau JT, Mayman DJ, Jules-Elysee KM, Lin Y, Padgett DE, DeMeo DA, et al. Effect of Duloxetine on Opioid Use and Pain After Total Knee Arthroplasty: A Triple-Blinded Randomized Controlled Trial. J Arthroplasty. 2022;37(6S):S147-S154. doi: 10.1016/j.arth.2022.02.022. [PubMed: 35346549].
15. Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y. Duloxetine reduces pain and improves quality of recovery following total knee arthroplasty in centrally sensitized patients: A prospective, randomized controlled study. J Bone Joint Surg Am. 2019;101(1):64-73. doi: 10.2106/JBJS.18.00347. [PubMed: 30601417].
16. Li H, Zeng WN, Ding ZC, Yuan MC, Cai YR, Zhou ZK. Duloxetine reduces pain after Total hip arthroplasty: a prospective, randomized controlled study. BMC Musculoskelet Disord. 2021;22(1):492. doi: 10.1186/s12891-021-04377-4. [PubMed: 34049519]. [PubMed Central: PMC8161627].
17. Rienstra W, Blikman T, Dijkstra B, Stewart R, Zijlstra W, van Raaij T, et al. Effect of preoperative duloxetine treatment on postoperative chronic residual pain after total hip or knee arthroplasty: a randomized controlled trial. BMJ Open. 2021;11(11):e052944. doi: 10.1136/bmjopen-2021-052944. [PubMed: 34732491]. [PubMed Central: PMC8572398].
18. Jones IA, Talehakimi A, Murphy LS, Wang JC, Piple AS, Christ AB, et al. Duloxetine for postoperative pain control following knee or hip replacement: A systematic review and meta-analysis. Arthroplast Today. 2023;20:101097. doi: 10.1016/j.artd.2023.101097. [PubMed: 36852213]. [PubMed Central: PMC9957748].
19. Bedin A, Caldart Bedin RA, Vieira JE, Ashmawi HA. Duloxetine as an analgesic reduces opioid consumption after spine surgery: A randomized, double-blind, controlled study. Clin J Pain. 2017;33(10):865-9. doi: 10.1097/AJP.0000000000000471. [PubMed: 28002096].
20. Su P, Pang L, Li S, Sun W, Zhao Y, Fu W, et al. Evaluation of analgesic efficacy and opioid-sparing effect of duloxetine after arthroscopic rotator cuff repair: A randomized clinical trial. Clin J Pain. 2022;38(5):328-33. doi: 10.1097/AJP.0000000000001032. [PubMed: 35413023].
21. Altiparmak B, Guzel C, Gumus DS. Comparison of preoperative administration of pregabalin and duloxetine on cognitive functions and pain management after spinal surgery: A randomized, double-blind, placebo-controlled Study. Clin J Pain. 2018;34(12):1114-20. doi: 10.1097/AJP.0000000000000640. [PubMed: 30020088].
22. Otsuki S, Okamoto Y, Ikeda K, Wakama H, Okayoshi T, Neo M. Perioperative duloxetine administration reduces pain after high tibial osteotomy and non-steroidal anti-inflammatory administration: A prospective, controlled study. Knee. 2022;38: 42-9. doi: 10.1016/j.knee.2022.07.006. [PubMed: 35908360].
2. Eckhard L, Jones T, Collins JE, Shrestha S, Fitz W. Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(7):2167-72. doi: 10.1007/s00167-019- 05449-8. [PubMed: 30826856].
3. Magni G. The use of antidepressants in the treatment of chronic pain. A review of the current evidence. Drugs. 1991;42(5):730-48. doi: 10.2165/00003495-199142050-00002. [PubMed: 1723371].
4. Hah J, Mackey SC, Schmidt P, McCue R, Humphreys K, Trafton J, et al. Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial. JAMA Surg. 2018;153(4):303-311. doi: 10.1001/jamasurg.2017.4915. Erratum in: JAMA Surg. 2018;153(4):396. doi: 10.1001/jamasurg.2018.0004. Erratum in: JAMA Surg. 2022;157(6):553. doi: 10.1001/jamasurg.2022.1392. [PubMed: 29238824]. [PubMed Central: PMC5933381].
5. Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs. 2009;23(6):523-41. doi: 10.2165/00023210-200923060-00006. [PubMed: 19480470].
6. Noshahr RM, Kouhestani E, Dibamehr M, Alshohaib M. The effect of duloxetine on postoperative pain and opium consumption in spine surgery: A systematic review. N Am Spine Soc J. 2024;17:100303. doi: 10.1016/j.xnsj.2023.100303. [PubMed: 38235484]. [PubMed Central: PMC10793159].
7. Gessner DM, Horn JL, Lowenberg DW. Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury. 2020;51(Suppl 2):S28-S36. doi: 10.1016/j.injury.2019.04.008. [PubMed: 31079833].
8. Briley M, Moret C. Treatment of comorbid pain with serotonin norepinephrine reuptake inhibitors. CNS Spectr . 2008;13(7 Suppl 11):22-6. doi: 10.1017/s1092852900028285. [PubMed: 18622371].
9. Rosenberg MB, Carroll FI, Negus SS. Effects of monoamine reuptake inhibitors in assays of acute pain-stimulated and pain-depressed behavior in rats. J Pain. 2013;14(3):246-59. doi: 10.1016/j.jpain.2012.11.006. [PubMed: 23332494]. [PubMed Central: PMC3743421].
10. Jost W, Marsalek P. Duloxetine: mechanism of action at the lower urinary tract and Onuf's nucleus. Clin Auton Res. 2004;14(4):220-7. doi: 10.1007/s10286-004-0197-8. [PubMed: 15316838].
11. Pergolizzi JV, Raffa RB, Taylor, Rodriguez G, Nalamachu S, Langley P. A review of duloxetine 60 mg once-daily dosing for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain. Pain Pract. 2013;13(3): 239-52. doi: 10.1111/j.1533-2500.2012.00578.x. [PubMed: 22716295].
12. Wernicke JF, Gahimer J, Yalcin I, Wulster-Radcliffe M, Viktrup L. Safety and adverse event profile of duloxetine. Expert Opin Drug Saf. 2005;4(6):987-93. doi: 10.1517/14740338.4.6.987. [PubMed: 16255658].
13. Polychroniou PE, Mayberg HS, Craighead WE, Rakofsky JJ, Aponte R, V, Haroon E, et al. Temporal profiles and dose- responsiveness of side effects with escitalopram and duloxetine in treatment-naive depressed adults. Behav Sci (Basel). 2018;8(7). doi: 10.3390/bs8070064. [PubMed: 30018196]. [PubMed Central: PMC6071033].
14. YaDeau JT, Mayman DJ, Jules-Elysee KM, Lin Y, Padgett DE, DeMeo DA, et al. Effect of Duloxetine on Opioid Use and Pain After Total Knee Arthroplasty: A Triple-Blinded Randomized Controlled Trial. J Arthroplasty. 2022;37(6S):S147-S154. doi: 10.1016/j.arth.2022.02.022. [PubMed: 35346549].
15. Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y. Duloxetine reduces pain and improves quality of recovery following total knee arthroplasty in centrally sensitized patients: A prospective, randomized controlled study. J Bone Joint Surg Am. 2019;101(1):64-73. doi: 10.2106/JBJS.18.00347. [PubMed: 30601417].
16. Li H, Zeng WN, Ding ZC, Yuan MC, Cai YR, Zhou ZK. Duloxetine reduces pain after Total hip arthroplasty: a prospective, randomized controlled study. BMC Musculoskelet Disord. 2021;22(1):492. doi: 10.1186/s12891-021-04377-4. [PubMed: 34049519]. [PubMed Central: PMC8161627].
17. Rienstra W, Blikman T, Dijkstra B, Stewart R, Zijlstra W, van Raaij T, et al. Effect of preoperative duloxetine treatment on postoperative chronic residual pain after total hip or knee arthroplasty: a randomized controlled trial. BMJ Open. 2021;11(11):e052944. doi: 10.1136/bmjopen-2021-052944. [PubMed: 34732491]. [PubMed Central: PMC8572398].
18. Jones IA, Talehakimi A, Murphy LS, Wang JC, Piple AS, Christ AB, et al. Duloxetine for postoperative pain control following knee or hip replacement: A systematic review and meta-analysis. Arthroplast Today. 2023;20:101097. doi: 10.1016/j.artd.2023.101097. [PubMed: 36852213]. [PubMed Central: PMC9957748].
19. Bedin A, Caldart Bedin RA, Vieira JE, Ashmawi HA. Duloxetine as an analgesic reduces opioid consumption after spine surgery: A randomized, double-blind, controlled study. Clin J Pain. 2017;33(10):865-9. doi: 10.1097/AJP.0000000000000471. [PubMed: 28002096].
20. Su P, Pang L, Li S, Sun W, Zhao Y, Fu W, et al. Evaluation of analgesic efficacy and opioid-sparing effect of duloxetine after arthroscopic rotator cuff repair: A randomized clinical trial. Clin J Pain. 2022;38(5):328-33. doi: 10.1097/AJP.0000000000001032. [PubMed: 35413023].
21. Altiparmak B, Guzel C, Gumus DS. Comparison of preoperative administration of pregabalin and duloxetine on cognitive functions and pain management after spinal surgery: A randomized, double-blind, placebo-controlled Study. Clin J Pain. 2018;34(12):1114-20. doi: 10.1097/AJP.0000000000000640. [PubMed: 30020088].
22. Otsuki S, Okamoto Y, Ikeda K, Wakama H, Okayoshi T, Neo M. Perioperative duloxetine administration reduces pain after high tibial osteotomy and non-steroidal anti-inflammatory administration: A prospective, controlled study. Knee. 2022;38: 42-9. doi: 10.1016/j.knee.2022.07.006. [PubMed: 35908360].
| Files | ||
| Issue | Vol 10 No 4 (2024) | |
| Section | Educational Corner | |
| DOI | https://doi.org/10.18502/jost.v10i4.17355 | |
| Keywords | ||
| Duloxetine Hydrochloride Orthopedics Pain Management | ||
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How to Cite
1.
Nankali A, Sabouri M, Gholamshahi H. Duloxetine for Postoperative Pain in Orthopedic Surgeries: A Review Article. J Orthop Spine Trauma. 2024;10(4):149-151.
