Imani Farnad, Emami Azadeh, Alimian Mahzad, Nikoubakht Nasim, Khosravi Niloofar, Rajabi Mehdi, Hertling Arthur Christopher
Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
Anesth Pain Med. 2023 Feb 6;13(1):e127017. doi: 10.5812/aapm-127017. eCollection 2023 Feb.
Chronic residual pain after total knee arthroplasty (TKA) is one of the challenges of postoperative pain management. Duloxetine, by controlling neuropathic pain, and pregabalin, by affecting nociceptors, can effectively manage postoperative pain.
This study aimed to compare the effect of perioperative oral duloxetine and pregabalin in pain management after knee arthroplasty.
In this clinical trial, 60 patients scheduled for TKA under spinal anesthesia were randomly assigned to one of three groups A (pregabalin 75 mg), B (duloxetine 30 mg), and C (placebo). Drugs were administered 90 minutes before, 12, and 24 hours after surgery. The visual analog scale (VAS) score for pain, the first analgesic request time, postoperative analgesic consumption (i.v. paracetamol), and WOMAC score six months after surgery were recorded.
The VAS score and analgesic consumption 48 hours after TKA in groups A and B significantly decreased compared to the placebo (P < 0.05). The first analgesic request time was longer in groups A and B than in group C (P < 0.05). While the differences were statistically significant, they are most likely not clinically significant. The WOMAC score before and six months after arthroplasty did not differ between the groups (P > 0.05).
Perioperative oral pregabalin and duloxetine similarly reduce pain and the need for analgesic consumption within 48 hours after TKA but do not affect knee mobility status.
全膝关节置换术（TKA）后慢性残留疼痛是术后疼痛管理面临的挑战之一。度洛西汀可控制神经性疼痛，普瑞巴林可影响伤害感受器，二者均可有效管理术后疼痛。
本研究旨在比较围手术期口服度洛西汀和普瑞巴林对膝关节置换术后疼痛管理的效果。
在这项临床试验中，60例计划在脊髓麻醉下进行TKA的患者被随机分为三组：A组（普瑞巴林75毫克）、B组（度洛西汀30毫克）和C组（安慰剂）。在手术前90分钟、术后12小时和24小时给药。记录疼痛视觉模拟量表（VAS）评分、首次镇痛需求时间、术后镇痛药物消耗量（静脉注射对乙酰氨基酚）以及术后六个月的WOMAC评分。
与安慰剂相比，A组和B组在TKA术后48小时的VAS评分和镇痛药物消耗量显著降低（P<0.05）。A组和B组的首次镇痛需求时间比C组更长（P<0.05）。虽然差异具有统计学意义，但很可能不具有临床意义。三组在关节置换术前和术后六个月的WOMAC评分没有差异（P>0.05）。
围手术期口服普瑞巴林和度洛西汀在TKA术后48小时内对减轻疼痛和减少镇痛药物消耗的效果相似，但不影响膝关节活动状态。
