Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients A Prospective, Randomized Controlled Study
Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients A Prospective, Randomized Controlled Study
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DOI：
10.2106/jbjs.18.00347
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发表时间：
2019-01-02
影响因子：
5.3
通讯作者：
In, Yong
中科院分区：
文献类型：
--
作者：
Koh, In Jun;Kim, Man Soo;In, Yong
背景：不明原因的术后疼痛是全膝关节置换术(TKA)最可怕的并发症之一。持续的伤害性外周刺激，如慢性膝骨性关节炎的疼痛，可引起中枢敏感化，使中枢神经系统变得高度兴奋，导致对伤害性和非伤害性刺激的超敏。中枢性敏感型患者TKA术后可能更容易出现不明原因的疼痛。度洛西汀是一种选择性5-羟色胺去甲肾上腺素再摄取抑制剂(SNRI)，可以缓解中枢敏感化患者的疼痛，我们的目的是确定它是否能减轻中枢敏感化患者TKA术后的疼痛，提高患者的康复质量。方法：采用中心敏化问卷(CSI)对接受TKA的患者进行术前中枢敏化筛选。在464名计划进行单侧全膝关节置换术的原发性骨关节炎患者中，有80名患者被确定为集中敏感型，并纳入了研究。40例患者随机分为度洛西汀组(术前1天30 mg，术后6周)和对照组(不用度洛西汀)。采用简明疼痛问卷(BPI)、简表-36(SF-36)、间歇性和持续性骨关节炎疼痛(ICOAP)和汉密尔顿抑郁量表(Hamilton Depression Scale)评定疼痛和康复质量。结果：度洛西汀组患者在术后2-12周内的各项疼痛指标均优于对照组(p<；0.05)。度洛西汀组在术后2周的情绪和身体功能恢复质量也较好(均P<；0.05)。两组患者不良事件的发生率无差异。结论：相当数量的患者在全膝关节置换术前进行了集中致敏。外科医生应根据中枢敏化的严重程度，考虑选择性地将度洛西汀纳入多模式术后止痛方案，以最大限度地减少TKA术后持续性疼痛的可能性。
Background: Unexplained postoperative pain is one of the most feared complications of total knee arthroplasty (TKA). A persistent noxious peripheral stimulus, such as the pain of chronic knee osteoarthritis, can cause central sensitization in which the central nervous system becomes hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli. Patients with central sensitization may be more susceptible to unexplained pain after TKA. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor (SNRI), can ameliorate the pain associated with central sensitization, and we aimed to determine whether it could reduce postoperative pain and improve quality of recovery after TKA in patients with central sensitization.Methods: Patients undergoing TKA were screened for central sensitization preoperatively with use of the Central Sensitization Inventory (CSI). Among 464 patients with primary osteoarthritis who were scheduled for primary unilateral TKA, 80 were identified as being centrally sensitized and were included in the study. Forty patients were randomly assigned to the duloxetine group (30 mg 1 day before surgery and for 6 weeks after surgery), and 40 were randomized to the control group (no duloxetine). Pain and quality of recovery were assessed with use of the Brief Pain Inventory (BPI), the Short Form-36 (SF-36), the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), and the Hamilton Depression Scale. The prevalence of adverse medication effects was also noted.Results: The patients in the duloxetine group had better performance across pain metrics during the initial 2 to 12-week postoperative period (p < 0.05). The duloxetine group also had a superior quality of recovery 2 weeks after TKA, as indicated by emotional and physical functioning (all p < 0.05). There was no difference between groups in the prevalence of adverse events.Conclusions: A substantial number of patients are centrally sensitized before TKA. Surgeons should consider selective incorporation of duloxetine into the multimodal postoperative analgesic protocol, according to the severity of central sensitization, to minimize the possibility of persistent pain following TKA.