Evaluating the Effect of Duloxetine Premedication on Postoperative Analgesic Requirement in Patients undergoing Laparoscopic Cholecystectomies: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study

Clin J Pain. 2022 Jun 9. doi: 10.1097/AJP.0000000000001052. Online ahead of print.

Abstract

Objective: The aim was to assess the effect of oral administration of preoperative duloxetine on postoperative pain and total analgesic requirement in the postoperative period as the primary objective. The secondary objective was to assess the perioperative hemodynamic parameters, sedation scores, demographic data and incidence of side effects (if any) in patients undergoing laparoscopic cholecystectomy.

Methods: This was a prospective, randomized, double blind, placebo-controlled study conducted in a tertiary level medical college on 60 patients of either gender posted for laparoscopic cholecystectomies with American Society of Anesthesiologists (ASA) I and II. The patients were divided into two groups (n=30), received duloxetine 60 mg capsules and placebo capsules (Becosules) 2 hours before surgery.

Results: The total requirement of both first and second rescue analgesic was higher in placebo as compared to duloxetine and found to be significant (P<0.05). The difference in mean Visual Analogue Scale (VAS) score was significantly (P<0.001) higher in placebo as compared to duloxetine at all time intervals postoperatively 0 mins (7.6±0.7 vs. 4.6±0.8); 15 mins (5.9±0.8 vs. 4.2±1.0); 30 mins (4.4±0.5 vs. 3.6±0.9); 4 hrs (6.6±0.06 vs. 5.3±1.3); 8 hrs (5.2±1.2 vs. 3.9±1.0) and 12 hrs (5.1±1.3 vs. 2.3±0.7). The mean arterial blood pressure (MAP) and heart rate (HR) was significantly higher in placebo compared to duloxetine in most of the time intervals in perioperative period. There was no significant difference in the sedation score between the groups except the 30 mins and 8 hours post operative.

Discussion: Preoperative oral Duloxetine during laparoscopic cholecystectomy could reduce postoperative pain, postoperative analgesic requirements and better optimization of hemodynamics without causing major side effects.