Duloxetine reduces pain after Total hip arthroplasty: a prospective, randomized controlled study

BackgroundPrevious studies have demonstrated the efficacy of duloxetine in reducing postoperative pain and opioid consumption. However, the effect of duloxetine on total hip arthroplasty (THA) remains unclear. The objective of this study was to assess the efficacy of oral duloxetine in THA.MethodsWe enrolled 96 patients in this randomized controlled trial. These patients were randomized (1,1) to either the duloxetine group or the placebo group and received daily doses of 60mg duloxetine or placebo, respectively, from 2 d pre-operation to 14 d after surgery. The primary outcome was pain severity upon movement measured by a visual analogue scale (VAS). The secondary outcomes included VAS scores for resting pain, morphine consumption, Harris Hip Score, patient satisfaction at discharge, length of postoperative hospital stay, and adverse events.ResultsPatients in the duloxetine group had significantly lower pain severity scores upon movement within 3 postoperative weeks (p<0.05) while none of the differences met the minimum clinically important difference (MCID). Moreover, patients in the duloxetine group performed better in terms of resting pain (in 3weeks after surgery), morphine requirements, and satisfaction level at discharge (all p<0.05). There was no difference between groups in the prevalence of adverse events.ConclusionsAlthough it did not result in a clinically meaning reduction in pain after total hip arthroplasty, perioperative administration of 60mg of duloxetine daily significantly alleviated pain in the postoperative 3weeks and morphine requirements during the postoperative 48h. Therefore, duloxetine still shows promise in optimizing the multimodal pain-management protocols in total hip arthroplasty.Trial registrationChinese Clinical Trial Registry, ChiCTR2000033606, 06/06/2020.

Automated summary

This study found that perioperative administration of 60mg duloxetine daily significantly reduced pain severity upon movement, resting pain, morphine requirements, and increased satisfaction level at discharge within 3 weeks after total hip arthroplasty. However, there was no clinically meaningful difference between the duloxetine group and the placebo group in terms of pain reduction. Adverse events did not differ between groups.