Abstract
Study objectiveSelective-serotonin-noradrenaline-reuptake inhibitors (SSNRI) might be an interesting option for postoperative pain treatment. Objective was to investigate postoperative pain outcomes of perioperative SSNRI compared to placebo or other additives in adults undergoing surgery. DesignSystematic review of randomised controlled trials (RCT) with meta-analysis and GRADE assessment. SettingAcute and chronic postoperative pain treatment. PatientsAdult patients undergoing surgery. InterventionsPerioperative administration of SSNRI. MeasurementsPrimary 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 resultsFourteen 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). ConclusionAt 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
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
