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Perioperative Duloxetine to Improve Postoperative Recovery After Abdominal Hysterectomy: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study

Castro-Alves, Lucas J. MD*; Oliveira de Medeiros, Andrea Cristina Pereira MD*; Neves, Saulo Pimentel MD*; Carneiro de Albuquerque, Camila Lucena MD*; Modolo, Norma Sueli MD; De Azevedo, Vera Lucia*; De Oliveira, Gildasio S. Jr. MD, MSCI

doi: 10.1213/ANE.0000000000000971
Anesthetic Pharmacology: Research Report

BACKGROUND: Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy.

METHODS: The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60 mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error.

RESULTS: Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4–20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0–5) mg IV morphine compared with 5.5 (0.5–9) mg IV morphine (P = 0.004). Nausea, vomiting, and time to postanesthesia care unit discharge were not significantly reduced in the duloxetine group compared with placebo.

CONCLUSIONS: Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.

Published ahead of print September 29, 2015

From the *Department of Anesthesiology, Santo Antonio Hospital, Salvador, Bahia, Brazil; Botucatu Medical School, Botucatu, Sao Paulo, Brazil; and Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Accepted for publication June 16, 2015.

Published ahead of print September 29, 2015

Funding: Institutional.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Gildasio S. De Oliveira, Jr., MD, MSCI, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St., F5-704, Chicago, IL 60611. Address e-mail to g-jr@northwestern.edu.

© 2016 International Anesthesia Research Society