Duloxetine may not impact patients’ opioid use, sleep duration or outcomes after TKA
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Key takeaways:
- Patients with central sensitization who received duloxetine slept 1.4 more hours on average in the first week after total knee arthroplasty.
- The duloxetine cohort had an adverse reaction rate of 8.5%.
SAN FRANCISCO — Results presented here showed the perioperative administration of duloxetine may not impact opioid requirements, sleep duration or patient-reported outcomes after primary total knee arthroplasty.
“However, among patients with central sensitization, those in the duloxetine cohort reported improvements in sleep duration and quality, indicating that duloxetine may improve recovery in this specific patient population,” Jaewon (Freddy) Yang, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Yang and colleagues randomly assigned 151 patients undergoing primary TKA to take either 30 mg of duloxetine (n=82) or placebo (n=69) daily starting 1 week prior to surgery until 4 weeks following surgery. At that point, they began taking the medication every other day. Researchers screened all patients for central sensitization using the Central Sensitization Inventory.
“The primary outcome was postoperative opioid consumption in the 2 weeks following surgery, and our secondary outcomes evaluated pain and [Knee Injury and Osteoarthritis Outcome Score for Joint Replacement] KOOS JR scores, as well as sleep quality, duration and adverse medication reactions,” Yang said.
According to Yang, 29 patients had central sensitization as diagnosed with a Central Sensitization Inventory score of greater than or equal to 30.
“We found that when evaluating all patients in both intention-to-treat and per protocol analysis there were no significant differences in any of our outcome measures,” Yang said. “However, when evaluating only the subset of patients with central sensitization, those in the duloxetine cohort slept longer and felt more well-rested following surgery.”
He added patients with central sensitization who received duloxetine slept an average of 1.4 more hours in the first week and reported feeling more well-rested. In the second week, Yang said increased feelings of being well-rested approached but did not reach statistical significance. Per protocol analysis also showed significant differences in sleep duration and being well-rested in the first week after surgery and differences that approached statistical significance in the second week.
“A total of 11 patients reported adverse reactions, for an overall adverse reaction rate of 7.3%,” Yang said. “Among the duloxetine cohort, the adverse reaction rate was 8.5%.”
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Yang JF, et al. Paper 74. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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