{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T23:39:15Z","timestamp":1775345955574,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2019,7,10]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Multimodal analgesia is a fundamental part of modern surgery and enhanced recovery pathways. Duloxetine, a serotonin and norepinephrine reuptake inhibitor, has been validated for the treatment of chronic neuropathic pain. The evidence for duloxetine as an adjunct for the treatment of acute postoperative pain remains controversial. We conducted a meta-analysis to determine the efficacy of duloxetine in the acute perioperative setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A literature search was conducted in the major databases (PubMed, EMBASE and Google Scholar) for randomized controlled trials (RCTs) evaluating duloxetine compared with placebo control for acute postoperative pain. The primary outcome was postoperative pain assessed at 2, 4, 6, 24 and 48\u2009hours time frames. Secondary outcomes included postoperative opioid administration, as well as side effects, such as postoperative nausea\/vomiting (PONV), pruritus, dizziness and headache.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>574 patients (n=9 RCTs) were included in the analysis, divided between duloxetine (n=285 patients) and placebo (n=289 patients). Duloxetine use was associated with a significant reduction in pain scores as early as 4 (mean difference (MD) \u22120.9, 95% CI \u22121.33 to \u22120.47) and as late as 48 (MD \u22120.94, 95%\u2009CI \u22121.56 to \u22120.33)\u2009hours postoperatively compared with placebo. In addition, duloxetine was associated with a significant reduction in opioid administration at 24 (standardized MD (SMD) \u22122.24, 95%\u2009CI \u22124.28 to \u22120.19) and 48 (SMD \u22122.21, 95%\u2009CI \u22124.13 to \u22120.28)\u2009hours as well as a significant reduction in PONV (risk ratio 0.69, 95%\u2009CI 0.49 to 0.95, p=0.03) compared with placebo. There was no difference between groups in other side effects.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Duloxetine, a non-opioid neuromodulator, may provide efficacy for the treatment of acute perioperative pain. Additional prospective studies are required to establish optimal perioperative dosing regimens, role in the setting of a comprehensive multimodal analgesic plan and impact on chronic postsurgical pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42019121416<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2019-100687","type":"journal-article","created":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T06:48:59Z","timestamp":1564728539000},"page":"959-965","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Perioperative duloxetine for acute postoperative analgesia: a meta-analysis of randomized trials"],"prefix":"10.1136","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8140-8486","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Zorrilla-Vaca","sequence":"first","affiliation":[{"name":"Anesthesiology, Universidad del Valle, Cali, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1079-206X","authenticated-orcid":false,"given":"Alexander","family":"Stone","sequence":"additional","affiliation":[{"name":"Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres Fabricio","family":"Caballero-Lozada","sequence":"additional","affiliation":[{"name":"Anesthesiology, Universidad del Valle, Cali, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephania","family":"Paredes","sequence":"additional","affiliation":[{"name":"Medicine, Icesi University, Cali, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Conrad","family":"Grant","sequence":"additional","affiliation":[{"name":"Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"key":"2025101110150740000_44.10.959.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14966-5"},{"key":"2025101110150740000_44.10.959.2","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2377-9-6","article-title":"Meta-Analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain","volume":"9","author":"Quilici","year":"2009","journal-title":"BMC Neurol"},{"key":"2025101110150740000_44.10.959.3","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000012391","article-title":"Comparison of perioperative flurbiprofen axetil or celecoxib administration for pain management after total-knee arthroplasty: a retrospective study","volume":"97","author":"Xiao","year":"2018","journal-title":"Medicine"},{"key":"2025101110150740000_44.10.959.4","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/ALN.0b013e3181e89a93","article-title":"Block of neuronal Na+ channels by antidepressant duloxetine in a state-dependent manner","volume":"113","author":"Wang","year":"2010","journal-title":"Anesthesiology"},{"key":"2025101110150740000_44.10.959.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-017-0450-z","article-title":"Perioperative duloxetine and Etoricoxibto improve postoperative pain after lumbar laminectomy: a randomized, double-blind, controlled study","volume":"17","author":"Attia","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"2025101110150740000_44.10.959.6","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1097\/AJP.0000000000000471","article-title":"Duloxetine as an analgesic reduces opioid consumption after spine surgery: a randomized, double-blind, controlled study","volume":"33","author":"Bedin","year":"2017","journal-title":"Clin J Pain"},{"key":"2025101110150740000_44.10.959.7","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/ALN.0000000000001228","article-title":"Duloxetine and subacute pain after knee arthroplasty when added to a multimodal analgesic regimen: a randomized, placebo-controlled, Triple-blinded trial","volume":"125","author":"YaDeau","year":"2016","journal-title":"Anesthesiology"},{"key":"2025101110150740000_44.10.959.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03530240045039"},{"key":"2025101110150740000_44.10.959.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000100","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"6","author":"Liberati","year":"2009","journal-title":"PLoS Med"},{"key":"2025101110150740000_44.10.959.10","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"2025101110150740000_44.10.959.11","unstructured":"Repchinsky C . Compendium of of pharmaceuticals and specialties (CPS): the Canadian drug reference for health professionals. Canadian Pharmacists Association, 2008."},{"key":"2025101110150740000_44.10.959.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2006.04.004"},{"key":"2025101110150740000_44.10.959.13","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1097\/AJP.0000000000000640","article-title":"Comparison of preoperative administration of pregabalin and duloxetine on cognitive functions and pain management after spinal surgery: a randomized, double-blind, placebo-controlled study","volume":"34","author":"Altiparmak","year":"2018","journal-title":"Clin J Pain"},{"key":"2025101110150740000_44.10.959.14","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1213\/ANE.0000000000000971","article-title":"Perioperative duloxetine to improve postoperative recovery after abdominal hysterectomy: a prospective, randomized, double-blinded, placebo-controlled study","volume":"122","author":"Castro-Alves","year":"2016","journal-title":"Anesth Analg"},{"key":"2025101110150740000_44.10.959.15","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq158"},{"key":"2025101110150740000_44.10.959.16","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/sja.SJA_519_17","article-title":"Impact of duloxetine and dexamethasone for improving postoperative pain after laparoscopic gynecological surgeries: a randomized clinical trial","volume":"12","author":"Kassim","year":"2018","journal-title":"Saudi J Anaesth"},{"key":"2025101110150740000_44.10.959.17","doi-asserted-by":"crossref","first-page":"64","DOI":"10.2106\/JBJS.18.00347","article-title":"Duloxetine reduces pain and improves quality of recovery following total knee arthroplasty in centrally sensitized patients: a prospective, randomized controlled study","volume":"101","author":"Koh","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"2025101110150740000_44.10.959.18","doi-asserted-by":"crossref","unstructured":"Nasr DA . Efficacy of perioperative duloxetine on acute and chronic postmastectomy pain. Ain-Shams J Anaesthesiol 2014;7.","DOI":"10.4103\/1687-7934.133345"},{"key":"2025101110150740000_44.10.959.19","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e328330373a"},{"key":"2025101110150740000_44.10.959.20","doi-asserted-by":"crossref","first-page":"3372","DOI":"10.1016\/j.arth.2018.07.028","article-title":"Predictive factors for developing chronic pain after total knee arthroplasty","volume":"33","author":"Kim","year":"2018","journal-title":"J Arthroplasty"},{"key":"2025101110150740000_44.10.959.21","first-page":"123","article-title":"Duloxetine, an antidepressant with analgesic properties - a preliminary analysis","volume":"22","author":"Onu\u0163u","year":"2015","journal-title":"Rom J Anaesth Intensive Care"},{"key":"2025101110150740000_44.10.959.22","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1213\/ANE.0000000000001086","article-title":"R-Duloxetine and N-methyl duloxetine as novel analgesics against experimental postincisional pain","volume":"122","author":"Wang","year":"2016","journal-title":"Anesth Analg"},{"key":"2025101110150740000_44.10.959.23","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1213\/ANE.0000000000000794","article-title":"The local and systemic actions of duloxetine in allodynia and hyperalgesia using a rat skin incision pain model","volume":"121","author":"Wang","year":"2015","journal-title":"Anesth Analg"},{"key":"2025101110150740000_44.10.959.24","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2002.461015.x"},{"key":"2025101110150740000_44.10.959.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2004.05.005"},{"key":"2025101110150740000_44.10.959.26","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/ALN.0000000000000307","article-title":"Antidepressant drugs for prevention of acute and chronic postsurgical pain: early evidence and recommended future directions","volume":"121","author":"Wong","year":"2014","journal-title":"Anesthesiology"},{"key":"2025101110150740000_44.10.959.27","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1097\/ALN.0000000000001229","article-title":"Duloxetine for subacute pain management after total knee arthroplasty: should we write it off or reevaluate?","volume":"125","author":"Jacobs","year":"2016","journal-title":"Anesthesiology"},{"key":"2025101110150740000_44.10.959.28","doi-asserted-by":"publisher","DOI":"10.1179\/106698108790818512"},{"key":"2025101110150740000_44.10.959.29","doi-asserted-by":"publisher","DOI":"10.2165\/11318930-000000000-00000"},{"key":"2025101110150740000_44.10.959.30","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1213\/ANE.0000000000001120","article-title":"The effect of preoperative gabapentin on postoperative nausea and vomiting: a meta-analysis","volume":"122","author":"Grant","year":"2016","journal-title":"Anesth Analg"},{"key":"2025101110150740000_44.10.959.31","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1213\/ANE.0000000000001404","article-title":"The effect of preoperative pregabalin on postoperative nausea and vomiting: a meta-analysis","volume":"123","author":"Grant","year":"2016","journal-title":"Anesth Analg"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2019-100687","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:15:15Z","timestamp":1760202915000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2019-100687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,1]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,9,18]]},"published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1136\/rapm-2019-100687"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2019-100687","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,1]]}}}