title: Duloxetine as an Analgesic Reduces Opioid Consumption After Spine Surgery: A Randomized, Double-Blind, Controlled Study.
abstract: OBJECTIVE
  Multimodal analgesia is widely advocated for the control of perioperative pain in an effort to reduce the use of opioid. Duloxetine is a selective inhibitor of serotonin and norepinephrine reuptake with efficacy for chronic pain conditions. The primary objective of this study was to evaluate the efficacy of two 60 mg oral doses of duloxetine in terms of fentanyl consumption during the postoperative period in patients undergoing elective spine surgery.
  
  
  METHODS
  This study was prospective, double-blind, randomized, and placebo controlled. Patients received either 60 mg duloxetine or an identical placebo 1 hour before surgery and again the following morning. The study participants were allocated into 2 groups: Group C (control) participants received the placebo and Group D (duloxetine) participants received 60 mg duloxetine. The total consumption of fentanyl 48 hours after surgery was measured. Secondary end points were pain scores and the presence or absence of adverse effects, such as headache, nausea, vomiting, itching, dizziness, and drowsiness.
  
  
  RESULTS
  Demographic characteristics did not differ between groups. There was a significant difference in fentanyl consumption in the first 24 hours between Groups C and D (mean difference, 223.11±39.32 µg; P<0.001). Fentanyl consumption also differed between Groups C and D after 48 hours (mean difference, 179.35±32.55 µg; P<0.000). The pain scores over 48 hours did not significantly differ between groups. The incidence of side-effects was similar in both groups.
  
  
  CONCLUSIONS
  Duloxetine was effective as an adjunct for postoperative analgesia and reduced opioid consumption.
authors.affiliation: *Department of Anesthesiology, University of Joinville Region, Joinville †Department of Anesthesiology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bedin
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Caldart Bedin
authors.forename: Joaquim E
authors.initials: JE
authors.lastname: Vieira
authors.forename: Hazem A
authors.initials: HA
authors.lastname: Ashmawi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000768:Anesthesia, General; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D000068736:Duloxetine Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D000068736:Duloxetine Hydrochloride; D005283:Fentanyl