Benefits of Duloxetine for postoperative pain control after total joint arthroplasty

Perioperative administration of Duloxetine is efficacious and safe in minimizing postoperative pain and opioid use after lower extremity total joint arthroplasty.

This meta-analysis was carried out to determine Duloxetine's effectiveness in minimizing pain and postoperative opioid usage after arthroplasty.

A literature search was carried out to identify randomized controlled trials assessing Duloxetine  (selective norepinephrine reuptake inhibitor) for pain management following total hip and total knee arthroplasty. For postoperative days (PODs) 1, 3, 7, and 14, as well as post-surgery week 6 and post-surgery month 3, data from the visual analogue scale (VAS) for pain while moving and at rest were extracted. Data on opioid consumption were collected after 24, 48, and 72 hours. Inverse variance with random effects was used to analyze all data, which were then depicted as weighted mean differences.

Identification of eight studies was done. Seven of them were quantitatively analyzed. The intake of postoperative opioids at 48 and 72 hours was reduced by Duloxetine. Patients using Duloxetine reported significantly less pain on the VAS for discomfort at rest at POD 3, POD 7, and postoperative week 6.

Patients using Duloxetine reported considerably less pain on the VAS for pain upon movement at POD1, POD3, POD7, POD14, postoperative week 6, and postoperative month 3. Qualitative review of the outcome data illustrated a robust safety profile.

In people scheduled to undergo knee or hip replacement, Duloxetine seems to be beneficial for postoperative pain control. But, definitive conclusions are limited by study heterogeneity and small sample size. While there is a requirement for follow-up studies to assess the optimal dosage, patient population, and duration, strong preliminary data offer robust support for future large-scale effectiveness studies.