Department of Orthopedics, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, 523000, China.
Int J Clin Pharm. 2024 Feb;46(1):14-25. doi: 10.1007/s11096-023-01593-x. Epub 2023 Jun 9.
Although duloxetine has shown a positive effect on pain relief with hip and knee osteoarthritis, there is no pooled analysis of duloxetine for pain relief and opioid consumption in patients after total hip or knee arthroplasty.
This systematic review and meta-analysis aimed to analyze pain control, opioid consumption, and associated adverse events of perioperative administration of duloxetine after total hip or knee arthroplasty.
After being registered with PROSPERO (CRD42022323202), the databases of MEDLINE, PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from inception until March 20, 2023, for randomized controlled trials (RCTs). Primary outcomes were the visual Analog Scale (VAS) pain scores at rest (rVAS) and upon ambulation (aVAS). Secondary outcomes were postoperative opioid consumption quantified as oral morphine milligram equivalents (MMEs) and adverse effects of duloxetine.
Nine RCTs with 806 cases were included. Duloxetine was associated with lower VAS scores at different times after surgery (24 h, two weeks, and ≥ 3 months). Compared to placebo, perioperative daily duloxetine use significantly reduced daily opioid MMEs at 24 h (standard mean deviation [SMD] -0.71, 95% confidence interval [95% CI] -1.19 to -0.24, P = 0.003), three days (SMD -1.10, 95% CI -1.70 to -0.50, P = 0.0003), and one week (SMD -1.18, 95% CI -1.99 to -0.38, P = 0.004) after surgery. The duloxetine group had a significantly lower rate of nausea (odds ratio 0.62, 95% CI [0.41 to 0.94], P = 0.02) and a higher rate of drowsiness and somnolence (odds ratio 1.87, 95% CI [1.13 to 3.07], P = 0.01) compared to the placebo group. No significant differences were observed in the rates of other adverse events.
Perioperative duloxetine significantly decreased postoperative pain and opioid consumption with good safety profiles. Further high quality designed and well-controlled randomized trials are warranted.
尽管度洛西汀已显示出对髋、膝关节骨关节炎缓解疼痛的积极作用，但尚无关于度洛西汀在全髋关节或全膝关节置换术后患者缓解疼痛和减少阿片类药物消耗的汇总分析。
本系统评价和荟萃分析旨在分析全髋关节或全膝关节置换术后围手术期应用度洛西汀对疼痛控制、阿片类药物消耗以及相关不良事件的影响。
在 PROSPERO（CRD42022323202）注册后，检索 MEDLINE、PubMed、Embase、Web of Science、Cochrane Library 和 ClinicalTrials.gov 数据库，检索时间从建库至 2023 年 3 月 20 日，纳入随机对照试验（RCT）。主要结局为静息时（rVAS）和活动时（aVAS）的视觉模拟评分（VAS）疼痛评分。次要结局为术后阿片类药物消耗，以口服吗啡毫克当量（MME）表示，以及度洛西汀的不良反应。
共纳入 9 项 RCT 研究，共 806 例患者。与安慰剂相比，围手术期使用度洛西汀可降低术后不同时间的 VAS 评分（24 小时、2 周和≥3 个月）。与安慰剂相比，围手术期每日使用度洛西汀可显著减少术后 24 小时（标准均数差[SMD] -0.71，95%置信区间[95%CI] -1.19 至 -0.24，P=0.003）、3 天（SMD -1.10，95%CI -1.70 至 -0.50，P=0.0003）和 1 周（SMD -1.18，95%CI -1.99 至 -0.38，P=0.004）时的每日阿片类药物 MME。与安慰剂组相比，度洛西汀组恶心发生率较低（比值比 0.62，95%CI [0.41 至 0.94]，P=0.02），而困倦和嗜睡发生率较高（比值比 1.87，95%CI [1.13 至 3.07]，P=0.01）。其他不良反应发生率无显著差异。
围手术期使用度洛西汀可显著减轻术后疼痛和减少阿片类药物消耗，且安全性良好。需要进一步开展高质量、设计良好和严格对照的随机试验。
