Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia.
J Gynecol Obstet Hum Reprod. 2022 Mar;51(3):102305. doi: 10.1016/j.jogoh.2021.102305. Epub 2021 Dec 31.
To evaluate the efficacy and safety of preoperative duloxetine on postoperative pain management after gynecologic laparoscopic surgeries.
A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus from inception to September 2021. We selected randomized clinical trials (RCTs) that compared preoperative duloxetine (intervention group) versus placebo (control group) among women undergoing gynecologic laparoscopic surgeries. Our primary outcomes were pain scores evaluated by the Visual Analog Scale (VAS) at 2, 6, 12, and 24 h postoperatively. Our secondary outcomes were the time required for the first analgesic request in minutes, postoperative analgesic consumption in milligrams, length of hospital stay in days, and side effects.
Four RCTs with a total number of 244 patients were included in our systematic review and meta-analysis. We found duloxetine was linked to a significant reduction in VAS pain scores at different time intervals. The first analgesic request was significantly earlier in the placebo group than in the duloxetine group (p = 0.03). In addition, duloxetine significantly reduced the postoperative analgesic consumption compared to placebo (MD= -41.97, 95% CI [-53.23, -30.72], p<0.001). However, both groups did not differ in the length of hospital stay and side effects.
Duloxetine administration prior to gynecological laparoscopic surgeries is safe and effective in improving postoperative pain and analgesia.
评估术前度洛西汀用于妇科腹腔镜手术后疼痛管理的疗效和安全性。
系统检索 Cochrane 图书馆、PubMed、ISI web of science 和 Scopus 从建库至 2021 年 9 月的文献。我们选择了比较妇科腹腔镜手术中术前度洛西汀（干预组）与安慰剂（对照组）的随机临床试验（RCT）。我们的主要结局是术后 2、6、12 和 24 小时用视觉模拟评分（VAS）评估的疼痛评分。我们的次要结局是首次请求镇痛的时间（以分钟计）、术后镇痛消耗的毫克数、住院天数和副作用。
本系统评价和荟萃分析共纳入 4 项 RCT，共 244 例患者。我们发现度洛西汀与不同时间间隔的 VAS 疼痛评分显著降低相关。安慰剂组首次请求镇痛的时间明显早于度洛西汀组（p=0.03）。此外，与安慰剂相比，度洛西汀显著减少了术后镇痛消耗（MD=-41.97，95%CI[-53.23，-30.72]，p<0.001）。然而，两组在住院天数和副作用方面没有差异。
妇科腹腔镜手术前给予度洛西汀安全有效，可改善术后疼痛和镇痛效果。
