Barbosa Eduardo Cerchi, Ortegal Guilherme Henrique Pires Carvalho, de Andrade Lucas Santos, Costa Milena Rodrigues, Santos Andreia Moreira Silva
Department of Medicine, Evangelical University of Goiás, Avenida Universitária Km 3.5, Cidade Universitária, Anápolis, GO, 75083-515, Brazil.
Int J Clin Pharm. 2025 Apr;47(2):294-303. doi: 10.1007/s11096-024-01855-2. Epub 2025 Jan 15.
Recent studies suggest that duloxetine administration before non-laparoscopic surgery may reduce postoperative pain and analgesic requirement without increasing adverse event occurrence.
To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on preoperative administration of duloxetine versus placebo for postoperative pain relief in adults undergoing laparoscopic surgery, assessing efficacy- and safety-related outcomes.
We systematically searched MEDLINE, Embase, and Cochrane Library, covering all records up to July 19, 2024. Inclusion criteria consisted of RCTs comparing preoperative administration of duloxetine versus placebo in adults undergoing laparoscopic surgery and reporting at least one outcome of interest. The random-effects model was used to estimate the mean difference (MD) and risk ratio (RR), along with their respective 95% confidence intervals (95%CIs).
We included four RCTs (227 patients). Compared with placebo, duloxetine provided a statistically lower pain scores at 2 (MD - 1.04; 95%CI - 1.75, - 0.33), 4 (MD - 1.28; 95%CI - 1.77, - 0.79), 8 (MD - 1.22; 95%CI - 1.72, - 0.72), 12 (MD - 1.64; 95%CI - 2.88, - 0.41), and 24 h (MD - 1.05; 95%CI - 1.72, - 0.39) after surgery. Duloxetine also granted a statistically longer time to first analgesic requirement (MD 128.38 min; 95%CI 41.31, 215.46), compared with placebo. Additionally, the duloxetine group had a significantly lower risk of nausea/vomiting (RR 0.48; 95%CI 0.25, 0.90), while there were no significant differences between both groups for the risk of dizziness, headache, and somnolence.
Compared with placebo, duloxetine administration before laparoscopic surgery significantly minimized postoperative pain intensity, delayed analgesic requirement, and reduced nausea/vomiting risk.
近期研究表明，在非腹腔镜手术前给予度洛西汀可能会减轻术后疼痛并减少镇痛需求，且不会增加不良事件的发生。
对关于度洛西汀与安慰剂术前给药用于接受腹腔镜手术的成人术后疼痛缓解的随机对照试验（RCT）进行系统评价和荟萃分析，评估疗效和安全性相关结局。
我们系统检索了MEDLINE、Embase和Cochrane图书馆，涵盖截至2024年7月19日的所有记录。纳入标准包括比较度洛西汀与安慰剂术前给药用于接受腹腔镜手术的成人的RCT，并报告至少一项感兴趣的结局。采用随机效应模型估计平均差（MD）和风险比（RR）及其各自的95%置信区间（95%CI）。
我们纳入了四项RCT（227例患者）。与安慰剂相比，度洛西汀在术后2小时（MD -1.04；95%CI -1.75，-0.33）、4小时（MD -1.28；95%CI -1.77，-0.79）、8小时（MD -1.22；95%CI -1.72，-0.72）、12小时（MD -1.64；95%CI -2.88，-0.41）和24小时（MD -1.05；95%CI -1.72，-0.39）时的疼痛评分在统计学上更低。与安慰剂相比，度洛西汀组首次需要镇痛的时间在统计学上也更长（MD 128.38分钟；95%CI 41.31，215.46）。此外，度洛西汀组恶心/呕吐的风险显著更低（RR 0.48；95%CI 0.25，0.90），而两组在头晕、头痛和嗜睡风险方面无显著差异。
与安慰剂相比，腹腔镜手术前给予度洛西汀可显著降低术后疼痛强度、延迟镇痛需求并降低恶心/呕吐风险。
