Nair Abhijit, Thakre Manish, Rangaiah Manamohan, Dudhedia Ujjwalraj, Borkar Nitinkumar
Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Ibra-414, Sultanate of Oman.
Department of Psychiatry, Government Medical College, Nagpur, Maharashtra, India.
Indian J Anaesth. 2023 Sep;67(9):770-777. doi: 10.4103/ija.ija_170_23. Epub 2023 Sep 6.
Patients undergoing hysterectomy by open or laparoscopic approach experience moderate to severe postoperative pain. A multimodal analgesic approach is recommended for these patients. This study reviews the analgesic efficacy of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor used as an adjuvant for opioid-sparing postoperative analgesia.
After registering the protocol in the international prospective register of systematic reviews (PROSPERO), databases like PubMed, Ovid, Scopus, Cochrane Library and clinicaltrials.gov were searched for randomised controlled trials using relevant keywords to find studies in which duloxetine premedication was compared to a placebo in patients undergoing hysterectomy. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of evidence.
The qualitative systematic review included five of the 88 studies identified. The overall risk of bias in the included studies was very high. In all the studies, 60 mg oral duloxetine was used, and the control group was placebo. In two studies, duloxetine premedication was administered 2 h before and 24 h after surgery. In the other three studies, a single dose of 60 mg duloxetine was only administered 2 h before surgery. A pooled meta-analysis was not performed due to fewer studies that fulfilled the inclusion criteria and even fewer studies with consistent reporting of various outcomes.
The evidence is insufficient to advocate routine duloxetine premedication in patients undergoing hysterectomy.
接受开腹或腹腔镜子宫切除术的患者术后会经历中度至重度疼痛。推荐对这些患者采用多模式镇痛方法。本研究回顾了度洛西汀的镇痛效果，度洛西汀是一种选择性5-羟色胺和去甲肾上腺素再摄取抑制剂，用作减少阿片类药物用量的术后镇痛辅助药物。
在国际系统评价前瞻性注册库（PROSPERO）中注册方案后，使用相关关键词在PubMed、Ovid、Scopus、Cochrane图书馆和clinicaltrials.gov等数据库中检索随机对照试验，以查找在接受子宫切除术的患者中将度洛西汀术前用药与安慰剂进行比较的研究。使用修订后的Cochrane随机试验偏倚风险工具（RoB 2）评估证据质量。
定性系统评价纳入了所识别的88项研究中的5项。纳入研究的总体偏倚风险非常高。在所有研究中，均使用60mg口服度洛西汀，对照组为安慰剂。在两项研究中，度洛西汀术前用药在手术前2小时和术后24小时给药。在其他三项研究中，仅在手术前2小时给予单剂量60mg度洛西汀。由于符合纳入标准的研究较少，且报告各种结局一致的研究更少，因此未进行汇总荟萃分析。
证据不足，无法支持在接受子宫切除术的患者中常规使用度洛西汀进行术前用药。
