Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta‐analysis of randomized clinical trials

• Published in: Pain practice 2023-09, Vol.23 (7), p.818-837
• Main Authors: Govil, Nishith, Arora, Pankaj, Parag, Kumar, Tripathi, Mukesh, Garg, Pankaj Kumar, Goyal, Tarun
• Format: Article
• Language: English
• Subjects: acute pain; duloxetine; metanalysis; postoperative pain; systemic review
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.13253

Background Duloxetine has been used as an adjunct in multimodal analgesia for acute postoperative pain in clinical studies. This meta‐analysis aims to conclude whether oral duloxetine, when given perioperatively, is any better than a placebo in managing postoperative pain. Effects of duloxetine on postoperative pain scores, time to first rescue analgesia, postoperative rescue analgesia consumption, side effects attributable to duloxetine, and patient satisfaction profile were assessed. Method MEDLINE, Web of Science, EMBASE, Scholar Google, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched with keywords including “Duloxetine” AND “postoperative pain”, “Duloxetine” AND “acute pain” and with “Duloxetine” till October 2022. This meta‐analysis included randomized clinical trials in which perioperative duloxetine 60 mg per oral was administered not more than 7 days before surgery and for at least 24 after surgery but not more than 14 days after surgery. All RCTs in which the comparator is placebo and outcomes related to analgesic efficacy like pain scores, opioid consumption, and side effects of duloxetine until 48 h postoperatively were included. Data were extracted from the studies and a risk of bias summary was formed using the Cochrane Collaboration tool. Effect sizes were given as standardized mean differences for continuous outcomes and risk ratios (RR) by the Mantel–Haenszel test for the categorical outcome. Confirmation of publication bias was done by Egger's regression test (p