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Opioid Use and Pain After Total Knee Replacement

A June 2022 study (1) suggested duloxetine, a serotonin-norepinephrine dual reuptake inhibitor, may improve pain relief after a total knee arthroplasty.

  • A total of 160 patients received 60 mg duloxetine or placebo daily, starting from the day of surgery and continuing 14 days postoperatively.
  • Patients received neuraxial anesthesia, peripheral nerve blocks, acetaminophen, nonsteroidal anti-inflammatory drugs, and oral opioids as needed.
  • The dual primary outcomes were Numeric Rating Scale (NRS – pain scale) scores with movement on postoperative days 1, 2, and 14, and cumulative opioid consumption surgery through postoperative day 14.

Duloxetine was superior to placebo for both primary outcomes and was superior to placebo for reducing opioid consumption. Duloxetine reduced pain with walking, normal work, and sleep.

Overall, there was a 29% reduction in opioid use which corresponds to 17 fewer pills of oxycodone, 5 mg, and was achieved without increasing pain scores. The researchers write: “Considering the ongoing opioid epidemic, duloxetine can be used to reduce opioid usage after knee arthroplasty in selected patients that can be appropriately monitored for potential side effects of the medication.”

1 YaDeau JT, Mayman DJ, Jules-Elysee KM, Lin Y, Padgett DE, DeMeo DA, Gbaje EC, Goytizolo EA, Kim DH, Sculco TP, Kahn RL. Effect of Duloxetine on Opioid Use and Pain After Total Knee Arthroplasty: A Triple-Blinded Randomized Controlled Trial. The Journal of Arthroplasty. 2022 Jun 1;37(6):S147-54.

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