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. 2023 Sep;67(9):770-777.
doi: 10.4103/ija.ija_170_23. Epub 2023 Sep 6.

Analgesic efficacy and safety of duloxetine premedication in patients undergoing hysterectomy - A systematic review

Abhijit Nair  1 , Manish Thakre  2 , Manamohan Rangaiah  3 , Ujjwalraj Dudhedia  4 , Nitinkumar Borkar  5
Affiliations

Analgesic efficacy and safety of duloxetine premedication in patients undergoing hysterectomy - A systematic review

Abhijit Nair et al. Indian J Anaesth. 2023 Sep.

Abstract

Background and aims: Patients undergoing hysterectomy by open or laparoscopic approach experience moderate to severe postoperative pain. A multimodal analgesic approach is recommended for these patients. This study reviews the analgesic efficacy of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor used as an adjuvant for opioid-sparing postoperative analgesia.

Methods: After registering the protocol in the international prospective register of systematic reviews (PROSPERO), databases like PubMed, Ovid, Scopus, Cochrane Library and clinicaltrials.gov were searched for randomised controlled trials using relevant keywords to find studies in which duloxetine premedication was compared to a placebo in patients undergoing hysterectomy. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of evidence.

Results: The qualitative systematic review included five of the 88 studies identified. The overall risk of bias in the included studies was very high. In all the studies, 60 mg oral duloxetine was used, and the control group was placebo. In two studies, duloxetine premedication was administered 2 h before and 24 h after surgery. In the other three studies, a single dose of 60 mg duloxetine was only administered 2 h before surgery. A pooled meta-analysis was not performed due to fewer studies that fulfilled the inclusion criteria and even fewer studies with consistent reporting of various outcomes.

Conclusion: The evidence is insufficient to advocate routine duloxetine premedication in patients undergoing hysterectomy.

Keywords: Acute pain; analgesia; duloxetine; hysterectomy; length of hospital stay; meta-analysis; premedication; quality of recovery; surgery; systematic review.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow diagram showing the literature search process
Figure 2
Figure 2
Risk of bias and quality assessment: (a) traffic light plot showing the risk of bias within the trials; (b) summary plot showing quality assessment for each included study
See this image and copyright information in PMC

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