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Significant Analgesic Benefits of Perioperative Duloxetine in Patients Who Have Depressive Symptoms Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial

  • Zi-chuan Ding
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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  • Hao Li
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China

    Department of Joint Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
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  • Chao Huang
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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  • Ming-cheng Yuan
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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  • Jian Cao
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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  • Hao-yang Wang
    Correspondence
    Address correspondence to: Hao-yang Wang, Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China.
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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  • Zong-ke Zhou
    Correspondence
    Address correspondence to: Zong-ke Zhou, Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China.
    Affiliations
    Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P.R. China
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Published:October 14, 2022DOI:https://doi.org/10.1016/j.arth.2022.10.007

      Abstract

      Background

      Major symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients.

      Methods

      Among 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded.

      Results

      The duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups.

      Conclusion

      Perioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms.

      Keywords

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