Efficacy of Perioperative Duloxetine As a Part of Multimodal Analgesia in Laparoscopic Colorectal Cancer Surgeries

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2023 May 16

PMID 37194004

Authors

Diab Fuad Hetta

Montaser Abdelfatah Mohamed

Hany Ahmed Elmorabaa

Mirna Ismail Ahmed

Nourhan Alaa Elgalaly

Shereen Mamdouh Kamal

Affiliations

Soon will be listed here.

Abstract

Background: Although laparoscopic surgery provides earlier recovery, less morbidity and hospital stay, however, severe pain is still a problem after it. Duloxetine has been recently used in postoperative pain management. We tested perioperative duloxetine to evaluate its effect on patients undergoing laparoscopic colorectal cancer surgery.

Methods: Sixty patients were enrolled in this study divided into two equal groups; duloxetine group each patient received an oral duloxetine capsule (60 mg) 1st dose at night before surgery, the 2nd dose 1 h preoperative, and the 3rd dose 24 h postoperative. Placebo group received placebo capsules at the same times. The cumulative morphine consumption in 48 h, postoperative VAS score, quality of recovery (QoR-40 score), sedation, and adverse effects were evaluated.

Results: Duloxetine group had lower VAS scores compared to placebo group, (3 ± 0.69) VS. (4.17 ± 0.83), (2.5 ± 0.6) VS. (4.3 ± 0.9), (2.2 ± 0.7) VS. (3.9 ± 0.6), (1.6 ± 0.7) VS. (3.6 ± 0.8), (1.1 ± 0.8) VS. (3.7 ± 0.7), (0.7 ± 0.7) VS. (3.5 ± 0.8), (0.6 ± 0.7) VS. (3.5 ± 0.8) respectively, P ˂0.01. The cumulative morphine consumption was significantly reduced in the Duloxetine group compared to the placebo group (4.6 ± 2.9 vs. 11.3 ± 1.7 mg), P < 0.01. The total QoR-40 score for duloxetine group was (180.8 ± 4.5) vs. (156 ± 5.9) in placebo group (P < 0.01). Patients in Duloxetine group were more sedated in all the 48 h postoperatively in comparison to placebo group.

Conclusions: Perioperative duloxetine had reduced postoperative pain, decreased opioid consumption, and improved the quality of recovery in patients undergoing laparoscopic colorectal surgery.

References

El-Sherbiny W, Saber W, Askalany A, El-Daly A, Sleem A . Effect of intra-abdominal instillation of lidocaine during minor laparoscopic procedures. Int J Gynaecol Obstet. 2009; 106(3):213-5. DOI: 10.1016/j.ijgo.2009.04.016. View

Buchanan F, Myles P, Cicuttini F . Effect of patient sex on general anaesthesia and recovery. Br J Anaesth. 2011; 106(6):832-9. DOI: 10.1093/bja/aer094. View

Gornall B, Myles P, Smith C, Burke J, Leslie K, Pereira M . Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013; 111(2):161-9. DOI: 10.1093/bja/aet014. View

Fuad Hetta D, Elgalaly N, Mohammad M . The Efficacy of Preoperative Duloxetine in Patients Undergoing Major Abdominal Cancer Surgery: A Randomized Controlled Trial. Clin J Pain. 2021; 37(12):908-913. DOI: 10.1097/AJP.0000000000000983. View

Iyengar S, Webster A, Hemrick-Luecke S, Xu J, Simmons R . Efficacy of duloxetine, a potent and balanced serotonin-norepinephrine reuptake inhibitor in persistent pain models in rats. J Pharmacol Exp Ther. 2004; 311(2):576-84. DOI: 10.1124/jpet.104.070656. View

Rawla P, Sunkara T, Barsouk A . Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019; 14(2):89-103. PMC: 6791134. DOI: 10.5114/pg.2018.81072. View

Gough A, Chang S, Reddy S, Ferrigno L, Zerey M, Grotts J . Periprosthetic Anesthetic for Postoperative Pain After Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial. JAMA Surg. 2015; 150(9):835-40. DOI: 10.1001/jamasurg.2015.1530. View

Happich M, Schneider E, Boess F, Wilhelm S, Schacht A, Birklein F . Effectiveness of duloxetine compared with pregabalin and gabapentin in diabetic peripheral neuropathic pain: results from a German observational study. Clin J Pain. 2013; 30(10):875-85. DOI: 10.1097/AJP.0000000000000057. View

Sun Y, Li H, Zhu C, Hu W, Yang J, Zhao G . The analgesia effect of duloxetine on post-operative pain via intrathecal or intraperitoneal administration. Neurosci Lett. 2014; 568:6-11. DOI: 10.1016/j.neulet.2014.03.046. View

10.

Chou Y, Ou Y, Lan K, Jawan B, Chang S, Kung F . Preemptive analgesia installation during gynecologic laparoscopy: a randomized trial. J Minim Invasive Gynecol. 2005; 12(4):330-5. DOI: 10.1016/j.jmig.2005.05.005. View

11.

Wu C, Raja S . Treatment of acute postoperative pain. Lancet. 2011; 377(9784):2215-25. DOI: 10.1016/S0140-6736(11)60245-6. View

12.

Castro-Alves L, Oliveira de Medeiros A, Neves S, Carneiro de Albuquerque C, Modolo N, De Azevedo V . Perioperative Duloxetine to Improve Postoperative Recovery After Abdominal Hysterectomy: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study. Anesth Analg. 2015; 122(1):98-104. DOI: 10.1213/ANE.0000000000000971. View

13.

Marangell L, Clauw D, Choy E, Wang F, Shoemaker S, Bradley L . Comparative pain and mood effects in patients with comorbid fibromyalgia and major depressive disorder: secondary analyses of four pooled randomized controlled trials of duloxetine. Pain. 2010; 152(1):31-37. DOI: 10.1016/j.pain.2010.05.029. View

14.

Boonstra A, Schiphorst Preuper H, Reneman M, Posthumus J, Stewart R . Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008; 31(2):165-9. DOI: 10.1097/MRR.0b013e3282fc0f93. View

15.

Govil N, Parag K, Arora P, Khandelwal H, Singh A . Perioperative duloxetine as part of a multimodal analgesia regime reduces postoperative pain in lumbar canal stenosis surgery: a randomized, triple blind, and placebo-controlled trial. Korean J Pain. 2020; 33(1):40-47. PMC: 6944370. DOI: 10.3344/kjp.2020.33.1.40. View

16.

Kaba A, Laurent S, Detroz B, Sessler D, Durieux M, Lamy M . Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007; 106(1):11-8. DOI: 10.1097/00000542-200701000-00007. View

17.

Lirk P, Thiry J, Bonnet M, Joshi G, Bonnet F . Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med. 2019; 44(4):425-436. DOI: 10.1136/rapm-2018-100024. View

18.

Mammoto T, Fujie K, Mamizuka N, Taguchi N, Hirano A, Yamazaki M . Effects of postoperative administration of celecoxib on pain management in patients after total knee arthroplasty: study protocol for an open-label randomized controlled trial. Trials. 2016; 17:45. PMC: 4724107. DOI: 10.1186/s13063-015-1106-2. View

19.

Ho K, Tay W, Yeo M, Liu H, Yeo S, Chia S . Duloxetine reduces morphine requirements after knee replacement surgery. Br J Anaesth. 2010; 105(3):371-6. DOI: 10.1093/bja/aeq158. View

20.

Kekelidze M, dErrico L, Pansini M, Tyndall A, Hohmann J . Colorectal cancer: current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation. World J Gastroenterol. 2014; 19(46):8502-14. PMC: 3870495. DOI: 10.3748/wjg.v19.i46.8502. View