scholarly journals Analgesic Effect of Perioperative Duloxetine in Patients After Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

2021 ◽  
Author(s):  
Mingcheng Yuan ◽  
Tingting Tang ◽  
Zichuan Ding ◽  
Hao Li ◽  
Zongke Zhou
Keyword(s):  
Total Knee Arthroplasty ◽  
Placebo Group ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Analgesic Effect ◽  
Controlled Trial ◽  
Double Blind ◽  
Management Protocol ◽  
Significant Difference ◽  
Total Knee

Abstract Background: To investigate the analgesic effect of perioperative use of duloxetine in patients received total knee arthroplasty (TKA). Method: The hospital pharmacy prepared small capsules containing either duloxetine or starch (placebo) which were all identical in appearance and weight (1:1). Enrolled patients were given a capsule (containing either 60 mg duloxetine or 60 mg placebo) every night before sleep since preoperative day 2 till postoperative day 14 (17 days in all) by a nurse who were not involved in this trial. Other perioperative managements were the same in the two groups. The primary outcome was the VAS score (both rVAS and aVAS) throughout the perioperative period. The secondary outcomes included opioid consumption, range of motion, including both active ROM (aROM) and passive ROM (pROM) and adverse events. Result: rVAS in duloxetine group were significantly less than placebo group throughout the postoperative period (From postoperative 2 hours to postoperative 3 months) (P<0.05). In terms of aVAS, similarly, duloxetine group had less aVAS than placebo group throughout the postoperative period (From postoperative 6 hours to postoperative 3 months) (P<0.05). During the postoperative period (From postoperative day 1 to 7), patients in duloxetine group consumed significantly less opioids per day than the placebo group (P<0.05). aROM in duloxetine group were significantly better than placebo group from postoperative 6 hours to postoperative day 5 (P<0.05), since postoperative day 6, the aROM became comparable between the two groups (P>0.05). In terms of pROM, duloxetine group had significantly better pROM from postoperative 6 hours to postoperative day 4 (P<0.05), thereafter, the pROM between the two groups became comparable (P>0.05). No significant difference was found between the two groups in the rates of dizziness, bleeding, sweating, fatigue and dryness of mouth. In the placebo group, more patients got nausea/vomiting and constipation (P<0.05). However, in terms of drowsiness, duloxetine group was reported higher rate (P<0.05). Conclusion: Duloxetine could reduce acute postoperative pain and decrease the opioids consumption as well as accelerating postoperative recovery, without increasing the risk of adverse medication effects in patients undergoing TKA. Duloxetine could act as a good supplement in multimodal pain management protocol for patients undergoing TKA. Trial registration statement: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033910). The date of registration was 06/16/2020.

scholarly journals Preemptive Duloxetine Relieves Postoperative Pain and Lowers Wound Temperature in Centrally Sensitized Patients Undergoing Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

2021 ◽  
Vol 10 (13) ◽  
pp. 2809
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Yong Gyu Sung ◽  
Dong Chul Park ◽  
Jae Won Na ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Placebo Group ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Central Sensitization ◽  
Controlled Trial ◽  
Wound Complications ◽  
Double Blind ◽  
Total Knee

(1) Background: The purpose of this study was to determine whether preemptive duloxetine in patients with central sensitization (CS) is effective for acute postoperative pain control and wound healing following total knee arthroplasty (TKA). (2) Methods: CS was defined as a score of 40 points or higher on the Central Sensitization Inventory (CSI) survey. Thirty-nine patients with CS were randomly assigned to either the duloxetine group (n = 19) or the placebo group (n = 20). The duloxetine group took duloxetine 30 mg once a day, while the placebo group took the placebo medication once a day. A pain visual analog scale (VAS) and the Brief Pain Inventory (BPI), wound complications, the temperature of the surgical site, and adverse events were investigated. Skin temperature was measured at the center of the patella using a portable digital thermometer. (3) Results: The duloxetine group reported significantly lower pain VAS scores during follow-up periods up to 6 weeks after surgery (all p < 0.05). BPI interference also showed significantly superior results in the duloxetine group after surgery (all p < 0.05). Although there was no difference in the rate of wound complications between the two groups (p > 0.05), the duloxetine group showed significantly lower wound temperature than the placebo group during the follow-up period (all p < 0.05). (4) Conclusion: In this study, preemptive duloxetine effectively reduced pain and lowered wound temperature following TKA in CS patients.

scholarly journals Preemptive Analgesia in Total Knee Arthroplasty: Comparing the Effects of Single Dose Combining Celecoxib with Pregabalin and Repetition Dose Combining Celecoxib with Pregabalin: Double-Blind Controlled Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Andri M. T. Lubis ◽  
Rangga B. V. Rawung ◽  
Aida R. Tantri
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Preemptive Analgesia ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Significant Difference ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with preemptive analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given preemptive analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as preemptive analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 (ClinicalTrials.gov).

scholarly journals Local Efficacy of Corticosteroids as an Adjuvant for Periarticular Cocktail Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Double-blind Controlled Trial

2020 ◽  
Author(s):  
huiming peng ◽  
wei wang ◽  
jin lin ◽  
xisheng weng ◽  
wenwei qian ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Visual Analog Scale ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Double Blind ◽  
Total Knee ◽  
Double Blinded ◽  
Hss Score

Abstract Background: Multimodal cocktail periarticular injection(MCPI) including corticosteroids is currently widely applied to reduce postoperative pain and swelling following total knee arthroplasty (TKA). However the addition of steroids is controversial.This prospective, double-blinded, randomized, controlled trial compares the safety and efficacy of MCPI with or without corticosteroids.Methods: A total of 60 patients (120 knees) who underwent simultaneous bilateral TKAs received periarticular injections with added betamethasone (7mg) in a randomly selected knee, and the other knee was injected without added corticosteroids. The visual analog scale(VAS) pain scores at rest and in motion, range of motion (ROM), thigh swelling, hospital for special surgery(HSS) score, and adverse events were compared between the 2 knees.Results: There were no statistically significant differences in the visual analog scale score, ROM, thigh girth, HSS score, and complications between the 2 kness. The patients were unable to detect a difference in the functional recovery between their knees on postoperative day 3or at the 3 month follow-up.Conclusion: Betamethasone injections are ineffective locally for relieving pain, reducing swelling, and improving the postoperative ROM.Trial registration: Chinese Clinical Trial RegistryNumber: ChiCTR-OPC-17013503, Date of Registration: 2017-11-23 URL:http://www.chictr.org.cn/showproj.aspx?proj=23146

scholarly journals INTRAARTICULAR EPSILON AMINOCAPROIC ACID VERSUS TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

2021 ◽  
Vol 29 (6) ◽  
pp. 312-315
Author(s):  
JOAO PAULO FERNANDES GUERREIRO ◽  
JOSE RODOLFO MARTINES BALBINO ◽  
BRUNO POSSANI RODRIGUES ◽  
MARCUS VINICIUS DANIELI ◽  
ALEXANDRE OLIVEIRA QUEIROZ ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Aminocaproic Acid ◽  
Osteoarthritis Of The Knee ◽  
Significant Difference ◽  
Total Knee ◽  
Double Blinded ◽  
Epsilon Aminocaproic Acid

ABSTRACT Objective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

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