度洛西汀治疗 TKA 或 THA 后患者的疗效和安全性：系统评价和荟萃分析。

BACKGROUND: Duloxetine, a serotonin-norepinephrine dual reuptake inhibitor, may improve analgesia after total joint arthroplasty (TJA). However, there is still no consensus on its effectiveness and safety. We conducted the meta-analysis to investigate the analgesic effect and safety of duloxetine for the treatment of patients received total knee or hip arthroplasty. METHODS: Pubmed, Cochrane Central Registry for Clinical Trials, Embase, OVID, Web of Science, and Google Scholar were searched using a predetermined search strategy from inception to September 21, 2022. Only randomized controlled trials of duloxetine in treatment of patients after total knee or hip arthroplasty were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS: A total of 8 randomized controlled trials with 739 patients were included in the literature review of postoperative pain and adverse effects. The result of meta-analysis showed statistically significant lower opioid requirement with duloxetine (P < .05) for the different postoperative period. Duloxetine group had significant reductions in visual analog score for the 24-hour (walking: WMD = -0.98; 95% confidence interval [CI] = -1.69 to -0.26, P = .007; resting: WMD = -1.06; 95%CI = -1.85 to -0.27, P = .008) and 1-week (walking: WMD = -0.96; 95%CI = -1.42 to -0.50, P < .001; resting: WMD = -0.69; 95%CI = -1.22 to -0.16, P = .01); knee injury and osteoarthritis outcome score over 3-month (WMD = 2.94; 95%CI = -0.30 to 6.18, P = .008) and complication (odds ratio = 4.74; 95%CI = 0.23 to 96.56, P = .01) postoperative period compared with the control group. However, no difference on numeric rating scale (P > .05) for the different postoperative period; visual analog score (P > .05) for the 6-week or 3-month and knee injury and osteoarthritis outcome score (P > .05) for the 6-week postoperative period. Furthermore, it did not increase the incidence of adverse effects (odds ratio = 0.87; 95%CI = 0.72 to 1.05, P = .15). CONCLUSION: Duloxetine could decrease the opioids consumption and relieve early postoperative pain without increasing the risk of adverse medication effects in patients undergoing total knee or hip arthroplasty. Considering the ongoing opioid epidemic, duloxetine could act as a good supplement in multimodal pain management protocol for patients undergoing total joint arthroplasty.

背景：度洛西汀是一种 5-羟色胺和去甲肾上腺素双重再摄取抑制剂，可能改善全关节置换术后的镇痛效果。然而，其有效性和安全性仍存在争议。我们进行了这项荟萃分析，以评估度洛西汀治疗全膝关节或全髋关节置换术后患者的镇痛效果和安全性。

方法：我们通过预设的搜索策略，检索了从成立到 2022 年 9 月 21 日的 Pubmed、Cochrane 临床试验中心注册库、Embase、OVID、Web of Science 和 Google Scholar 数据库，纳入度洛西汀治疗全膝关节或全髋关节置换术后患者的随机对照试验。根据 Cochrane 标准进行数据收集和提取、质量评估和数据分析。

结果：文献综述共纳入 8 项随机对照试验，涉及 739 名患者。荟萃分析结果显示，度洛西汀组在不同的术后时间段内，阿片类药物的需求量明显降低（P<0.05）。度洛西汀组在术后 24 小时（行走：WMD=-0.98；95%置信区间[CI]：-1.69 至-0.26，P=0.007；休息：WMD=-1.06；95%CI：-1.85 至-0.27，P=0.008）和 1 周（行走：WMD=-0.96；95%CI：-1.42 至-0.50，P<0.001；休息：WMD=-0.69；95%CI：-1.22 至-0.16，P=0.01）的视觉模拟评分（VAS）和术后 3 个月的膝关节损伤和骨关节炎结局评分（WMD=2.94；95%CI：-0.30 至 6.18，P=0.008）和并发症（比值比[OR]=4.74；95%CI：0.23 至 96.56，P=0.01）方面均优于对照组。然而，在不同的术后时间段内，VAS 评分（P>0.05）和数字评分量表（NRS）评分（P>0.05）无差异；术后 6 周和 3 个月的膝关节损伤和骨关节炎结局评分（P>0.05）无差异。此外，度洛西汀并未增加不良反应的发生率（OR=0.87；95%CI：0.72 至 1.05，P=0.15）。

结论：度洛西汀可减少全膝关节或全髋关节置换术后患者的阿片类药物用量，并缓解早期术后疼痛，且不增加不良药物反应的风险。考虑到当前阿片类药物滥用的流行，度洛西汀可以作为全关节置换术后多模式疼痛管理方案的良好补充。