Abstract | STUDY OBJECTIVE: DESIGN: Systematic review of randomised controlled trials (RCT) with meta-analysis and GRADE assessment. SETTING: PATIENTS: Adult patients undergoing surgery. INTERVENTIONS: Perioperative administration of SSNRI. MEASUREMENTS: Primary outcomes were postoperative acute pain at rest/during movement (measured on a scale from 0 to 10), number of patients with chronic postsurgical pain (CPSP) and with SSNRI-related adverse events. MAIN RESULTS: Fourteen RCTs (908 patients) were included. We have high-quality evidence that duloxetine has no effect on pain at rest at 2 h (MD: -0.02; 95% confidence interval (CI) -0.51 to 0.47), but probably reduces it at 48 h (MD: -1.16; 95%CI -1.78 to -0.54). There is low- and moderate-quality evidence that duloxetine has no effects on pain during movement at 2 h (MD: -0.42; 95%CI -1.53 to 0.69) and 48 h (MD: -0.91; 95% CI -2.08 to 0.26), respectively. We have very low-quality evidence that duloxetine might reduce pain at rest (MD: -0.45; 95%CI -0.74 to -0.15) and movement (MD: -1.19; 95%CI -2.32 to -0.06) after 24 h. We have low-quality evidence that duloxetine may reduce the risk of CPSP at 6 months (RR:0.35; 95%CI 0.14 to 0.90). There is moderate-quality evidence that duloxetine increases the risk of dizziness (RR:1.72; 95%CI 1.26 to 2.34). CONCLUSION: At the expense of a higher risk for dizziness, SSNRI may be effective in reducing postoperative pain between 24 and 48 h after surgery. However, the results of the meta-analyses are mostly imprecise and duloxetine might only be used in individual cases. Protocol registration: CRD42018094699.
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Authors | Alexander Schnabel, Stephanie Weibel, Sylvia U Reichl, Michael Meißner, Peter Kranke, Peter K Zahn, Esther M Pogatzki-Zahn, Christine H Meyer-Frießem |
Journal | Journal of clinical anesthesia
(J Clin Anesth)
Vol. 75
Pg. 110451
(12 2021)
ISSN: 1873-4529 [Electronic] United States |
PMID | 34311244
(Publication Type: Journal Article, Meta-Analysis, Systematic Review)
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Copyright | Copyright © 2021 Elsevier Inc. All rights reserved. |
Chemical References |
- Serotonin Uptake Inhibitors
- Serotonin
- Duloxetine Hydrochloride
- Norepinephrine
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Topics |
- Adult
- Duloxetine Hydrochloride
(adverse effects)
- Humans
- Norepinephrine
- Pain, Postoperative
(drug therapy, prevention & control)
- Serotonin
- Selective Serotonin Reuptake Inhibitors
(adverse effects)
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