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Research article
Yong In
Seoul St. Mary's Hospital, The Catholic University of Korea
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5932-3934
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Opioid is known to be effective in pain control after total knee arthroplasty (TKA). However, recently it has become a major concern due to addiction. Duloxetine, the serotonin-norepinephrine reuptake inhibitor, is effective for pain control in osteoarthritis patients. However, no study has compared the efficacy of the two for pain control after TKA. The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following TKA.
Methods
Among 857 patients, 260 (30.3%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score, and the rate over the minimum clinically significant difference (MCID) using WOMAC score) were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated.
Results
There was no significant difference in pain VAS score, WOMAC Pain and Function score, or the rate over MCID at each time point between before and after surgery (all p > 0.05). Fifteen (11.0%) patients in the opioid group and six (4.8%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p > 0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p > 0.05).
Conclusion
Duloxetine has a similar effect to opioid on postoperative pain control. Thus, duloxetine can be considered as an alternative to opioid for postoperative pain control following TKA.
Level of evidence:
Therapeutic study Level Ⅳ.
Keywords
Duloxetine, Selective serotonin and norepinephrine reuptake inhibitor, Opioid, Pain, Control, Total Knee Arthroplasty
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This is a preprint. It has not completed peer review.
Research article
Yong In
Seoul St. Mary's Hospital, The Catholic University of Korea
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5932-3934
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 04 Jun, 2020
No community comments so far
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Opioid is known to be effective in pain control after total knee arthroplasty (TKA). However, recently it has become a major concern due to addiction. Duloxetine, the serotonin-norepinephrine reuptake inhibitor, is effective for pain control in osteoarthritis patients. However, no study has compared the efficacy of the two for pain control after TKA. The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following TKA.
Methods
Among 857 patients, 260 (30.3%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score, and the rate over the minimum clinically significant difference (MCID) using WOMAC score) were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated.
Results
There was no significant difference in pain VAS score, WOMAC Pain and Function score, or the rate over MCID at each time point between before and after surgery (all p > 0.05). Fifteen (11.0%) patients in the opioid group and six (4.8%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p > 0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p > 0.05).
Conclusion
Duloxetine has a similar effect to opioid on postoperative pain control. Thus, duloxetine can be considered as an alternative to opioid for postoperative pain control following TKA.
Level of evidence:
Therapeutic study Level Ⅳ.
Figure 1
Figure 2
Figure 3
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