Pain Medicine  |   September 2016
Duloxetine and Subacute Pain after Knee Arthroplasty when Added to a Multimodal Analgesic Regimen: A Randomized, Placebo-controlled, Triple-blinded Trial
Author Notes
  • From the Departments of Anesthesiology (J.T.Y., Y.L., E.A.G., R.L.K., K.M.J.-E., A.K.G., Y.G.), Orthopaedic Surgery (D.J.M., M.M.A.), and Orthopaedics (D.E.P., G.W.), Hospital for Special Surgery, Weill Cornell Medical College, New York, New York; Pain Medicine, University of Michigan Health System, Ann Arbor, Michigan (C.M.B.); and Healthcare Research Institute, Hospital for Special Surgery, New York, New York (K.G.F.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Corresponding article on page 454.
    Corresponding article on page 454.×
  • Submitted for publication December 23, 2015. Accepted for publication May 26, 2016.
    Submitted for publication December 23, 2015. Accepted for publication May 26, 2016.×
  • Address correspondence to Dr. YaDeau: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021. yadeauj@hss.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Clinical Science / Pain Medicine
Pain Medicine   |   September 2016
Duloxetine and Subacute Pain after Knee Arthroplasty when Added to a Multimodal Analgesic Regimen: A Randomized, Placebo-controlled, Triple-blinded Trial
Anesthesiology 9 2016, Vol.125, 561-572. doi:10.1097/ALN.0000000000001228
Anesthesiology 9 2016, Vol.125, 561-572. doi:10.1097/ALN.0000000000001228
Abstract

Background: Duloxetine is effective for chronic musculoskeletal and neuropathic pain, but there are insufficient data to recommend the use of antidepressants for postoperative pain. The authors hypothesized that administration of duloxetine for 15 days would reduce pain with ambulation at 2 weeks after total knee arthroplasty.

Methods: In this triple-blinded, randomized, placebo-controlled trial, patients received either duloxetine or placebo for 15 days, starting from the day of surgery. Patients also received a comprehensive multimodal analgesic regimen including neuraxial anesthesia, epidural analgesia, an adductor canal block, meloxicam, and oxycodone/acetaminophen as needed. The primary outcome was the pain score (0 to 10 numeric rating scale) with ambulation on postoperative day 14.

Results: One hundred six patients were randomized and analyzed. On day 14, duloxetine had no effect on pain with ambulation; mean pain was 3.8 (SD, 2.3) for placebo versus 3.5 (SD, 2.1) for duloxetine (difference in means [95% CI], 0.4 [−0.5 to 1.2]; P = 0.386). Symptoms potentially attributable to duloxetine discontinuation at study drug completion (nausea, anxiety) occurred among nine patients (duloxetine) and five patients (placebo); this was not statistically significant (P = 0.247). Statistically significant secondary outcomes included opioid consumption (difference in mean milligram oral morphine equivalents [95% CI], 8.7 [3.3 to 14.1], P = 0.002 by generalized estimating equation) over the postoperative period and nausea on day 1 (P = 0.040). There was no difference in other side effects or in anxiety and depression scores.

Conclusions: When included as a part of a multimodal analgesic regimen for knee arthroplasty, duloxetine does not reduce subacute pain with ambulation.