Effect of duloxetine on opioid consumption and pain after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(4):11 Pain Med . 2023 Sep 1;24(9):1035-1045.What this means for my practice?
Overall, the results of this meta-analysis show that duloxetine is effective in reducing opioid consumption and pain intensity with no significant differences in adverse event rates, except for somnolence which was significantly lower in the control group. The study also found that duloxetine significantly reduced postoperative pain, but the observed benefits did not meet the minimum clinically important difference (MCID) of 1.3 points on an 11-point scale, questioning its clinical efficacy in pain management protocols. Despite statistical significance, the pain relief effects were below the MCID threshold as stated by the literature, highlighting a potential gap between statistical and clinical relevance. The results of this meta-analysis were limited by a small number of included studies, a high risk of bias, and considerable heterogeneity in duloxetine doses among the included studies.
Study Summary
Nine randomized controlled trials (806 patients) comparing the effect of duloxetine against a control in patients undergoing total hip or knee replacement (THA & TKA, respectively) were included in this systematic review and meta-analysis. Outcomes of interest included total opioid consumption, pain at rest and with activity on a Normalized Pain Scale (NPS), and the incidence of adverse events. Opioid consumption on days 2, 3, 7, and 14 favored the duloxetine group. Pain activity favored the duloxetine group at all time points except for 2 days and 6 weeks. Pain at rest favored the duloxetine group at 2, 3, 7, and 14 days with similar results at all other time points. All adverse events were similar among the two groups except for somnolence which favored the control group.
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