Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta‐analysis of randomized clinical trials.
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...
| Publicado en: | Pain Practice Vol. 23; no. 7; pp. 818 - 838 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Sep2023
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=171370637&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 171370637 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15307085 HYN jtl: Pain Practice issn: 15307085 maglogo: Y pubinfo: dt: Sep2023 vid: 23 iid: 7 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 171370637 163935670 171370637 171370637 10.1111/papr.13253 171370637 ppf: 818 ppct: 20 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta‐analysis of randomized clinical trials. aug: au: Govil, Nishith Arora, Pankaj Parag, Kumar Tripathi, Mukesh Garg, Pankaj Kumar Goyal, Tarun affil: Department of Anaesthesiology, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India sug: subj: Postoperative Pain Drug Therapy Duloxetine Hydrochloride Therapeutic Use Placebos Therapeutic Use Drug Efficacy Evaluation Pain Management Human Systematic Review Meta Analysis Duloxetine Hydrochloride Adverse Effects Patient Satisfaction Medline Embase Cochrane Library Duloxetine Hydrochloride Administration and Dosage Analgesics, Opioid Therapeutic Use Confidence Intervals Descriptive Statistics Regression Checklists ab: 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 < 0.05). If publication bias or heterogeneity was detected, the trim‐and‐fill method was used to calculate the adjusted effect size. Sensitivity analysis was done by leaving one out method after excluding the study with a high risk of bias. Subgroup analysis was done based on the type of surgery and gender. The study was prospectively registered in the PROSPERO under the registration number CRD42019139559. Findings: 29 studies with 2043 patients met the inclusion criteria and were reviewed for this meta‐analysis. Postoperative pain scores at 24 h [Std. Mean Difference (95% CI); −0.69 (−1.07, −0.32)] and at 48 h [−1.13 (−1.68, −0.58)] are significantly less with duloxetine (p‐value < 0.05). Time to first rescue analgesia was significantly more in patients where duloxetine was administered [1.27 (1.10, 1.45); p‐value > 0.05]. Opioid consumption up to 24 h [−1.82 (−2.46, −1.18)] and 48 h [−2.48 (−3.46, −1.50)] was significantly less (p‐value < 0.05) in patients who received duloxetine. Complications and recovery profiles were similar in patients receiving either duloxetine or a placebo. Interpretation: Based on GRADE findings, we conclude that there is low to moderate evidence to advocate the use of duloxetine for managing postoperative pain. Further trials are needed to replicate or refute these results based on robust methodology. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|