title: Perioperative Duloxetine to Improve Postoperative Recovery After Abdominal Hysterectomy: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study.
abstract: BACKGROUND
  Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy.
  
  
  METHODS
  The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60 mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error.
  
  
  RESULTS
  Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4-20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0-5) mg IV morphine compared with 5.5 (0.5-9) mg IV morphine (P = 0.004). Nausea, vomiting, and time to postanesthesia care unit discharge were not significantly reduced in the duloxetine group compared with placebo.
  
  
  CONCLUSIONS
  Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.
authors.affiliation: From the *Department of Anesthesiology, Santo Antonio Hospital, Salvador, Bahia, Brazil; †Botucatu Medical School, Botucatu, Sao Paulo, Brazil; and ‡Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Lucas J
authors.initials: LJ
authors.lastname: Castro-Alves
authors.forename: Andrea Cristina Pereira
authors.initials: AC
authors.lastname: Oliveira de Medeiros
authors.forename: Saulo Pimentel
authors.initials: SP
authors.lastname: Neves
authors.forename: Camila Lucena
authors.initials: CL
authors.lastname: Carneiro de Albuquerque
authors.forename: Norma Sueli
authors.initials: NS
authors.lastname: Modolo
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: De Azevedo
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001938:Brazil; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D000068736:Duloxetine Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000068736:Duloxetine Hydrochloride