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
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
References
1 H. Kehlet, T.S. Jensen, C.J. Woolf Persistent postsurgical pain: risk factors and prevention Lancet., 367 (2006), pp. 1618-1625
2 P. Phelps, O.S. Cakmakkaya, C.C. Apfel, et al. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial Obstet Gynecol., 111 (2008), pp. 1155-1160
3 S. Matsuzaki, K. Jardon, E. Maleysson, et al. Impact of intraperitoneal pressure of a CO2 pneumoperitoneum on the surgical peritoneal environment Hum Reprod., 27 (2012), pp. 1613-1623
4 H.W. Tsai, Y.J. Chen, C.M. Ho, et al. Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study Arch Surg., 146 (2011), pp. 1360-1366
5 J.B. Dixon, Y. Reuben, C. Halket, et al. Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery Obes Surg., 15 (2005), pp. 1111-1117
6 S.G. Kornstein, J.M. Russell, M.E. Spann, et al. Duloxetine in the treatment of generalized anxiety disorder Expert Rev Neurother., 9 (2009), pp. 155-165
7 C. Sommer, W. Hauser, R. Alten, et al. Drug therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline Schmerz., 26 (2012), pp. 297-310
8 J.B. King, M.B. Schauerhamer, B.K. Bellows A review of the clinical utility of duloxetine in the treatment of diabetic peripheral neuropathic pain Ther Clin Risk Manag., 11 (2015), pp. 1163-1175
9 M. Valadan, S. Banifatemi, F. Yousefshahi Preoperative Gabapentin to Prevent Postoperative Shoulder Pain After Laparoscopic Ovarian Cystectomy: A Randomized Clinical Trial Anesth Pain Med., 5 (2015), Article e31524
10 U. Gurunathan, I.L. Rapchuk, G. King, et al. The effect of pregabalin and celecoxib on the analgesic requirements after laparoscopic cholecystectomy: a randomized controlled trial J Anesth., 30 (2016), pp. 64-71
11 P. Shrivastav, P. Nadkarni, I. Craft Prevention of shoulder pain after laparoscopy Lancet., 339 (1992), p. 744
12 S.A. Jackson, A.S. Laurence, J.C. Hill Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia., 51 (1996), pp. 485-487
13 H.F. Sallam, N.W. Shady, H.F. Aly, et al. Low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain after gynecologic laparoscopy: randomized controlled trial International Surgery Journal., 5 (2018), p. 6
14 V. Pergialiotis, D.E. Vlachos, K. Kontzoglou, et al. Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials Surg Endosc., 29 (2015), pp. 2101-2108
15 P.M. Ingelmo, M. Bucciero, M. Somaini, et al. Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial Br J Anaesth., 110 (2013), pp. 800-806
16 A.W.H. Barazanchi, W.S. MacFater, J.L. Rahiri, et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update Br J Anaesth., 121 (2018), pp. 787-803
17 V. Bril, J. England, G.M. Franklin, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation Neurology., 76 (2011), pp. 1758-1765
18 D.L. Hershman, C. Lacchetti, C.L. Loprinzi Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Summary J Clin Oncol., 10 (2014), pp. e421-e424
19 A. Zorrilla-Vaca, A. Stone, A.F. Caballero-Lozada, et al. Perioperative duloxetine for acute postoperative analgesia: a meta-analysis of randomized trials Reg Anesth Pain Med. (2019) rapm-2019-100687
20 G. Wang, L. Bi, X. Li, et al. Efficacy and safety of duloxetine in Chinese patients with chronic pain due to osteoarthritis: a randomized, double-blind, placebo-controlled study Osteoarthritis Cartilage., 25 (2017), pp. 832-838
21 S.M. Hossain, S.M. Hussain, A.R. Ekram Duloxetine in Painful Diabetic Neuropathy: A Systematic Review Clin J Pain., 32 (2016), pp. 1005-1010
22 G.R. de Oliveira Filho, R.S. Kammer, H.C. Dos Santos Duloxetine for the treatment acute postoperative pain in adult patients: A systematic review with meta-analysis J Clin Anesth., 63 (2020), Article 109785