Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.035
Brazilian Journal of Anesthesiology
Original Investigation

Preoperative duloxetine to prevent postoperative shoulder pain after gynecologic laparoscopy: a randomized controlled trial

Ghada Mohammad Abo Elfadl; Ayman Mamdouh Osman; Mina Fayez Ghalyoom; Nawal Abdel-Aziz Gad Al-Rab; Mustafa Bahloul

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Abstract

Background
Gynecological laparoscopies despite being minimally invasive, have challenging multifactorial postoperative pain profile. We aimed to evaluate the effect of duloxetine in improving postoperative pain after gynecologic laparoscopies.

Methods
A prospective randomized controlled trial that recruited 60 patients who underwent laparoscopic surgery was randomly assigned to two groups who received similar capsules 12 hours before surgery, either duloxetine 60 mg intervention (case group) or placebo (control group). Patients were followed up 12 hours after surgery utilizing VAS for assessment of pain at shoulder, upper abdominal and trocar site, and Ramsay sedation score at 2, 6 and 12 hours after surgery. The first analgesic request and total analgesic requirement were recorded. Patient satisfaction were assessed 12 hours after surgery.

Results
Postoperative shoulder pain, upper abdominal pain, and pain at the trocar site were significantly lower in the intervention group over 12 hours postoperatively compared to placebo (p < 0.001). Ramsay sedation scores were significantly higher in the intervention group than in placebo for the first 2 hours postoperatively (p = 0.001). The first analgesic request was significantly earlier in placebo than in intervention group (p < 0.001). The total analgesic requirement within 12 hours postoperatively was significantly lower in the intervention than in placebo group. Dry mouth and postural hypotension were significantly more in the intervention group.

Conclusions
Duloxetine 60 mg given 12 hours before gynecological laparoscopic surgery proved to be safe and effective in improving postoperative analgesia, sedation and Patient satisfaction.

Keywords

Acute postoperative pain;  Laparoscopy;  Shoulder pain;  Duloxetine;  Postoperative analgesia;  Pneumoperitoneum;  Antineuropathic pain medications

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