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Duloxetine role in reducing opioid consumption after thoracotomy: a prospective, randomized, double -blinded, placebo - controlled pilot trial.

BACKGROUND
Exploration of the thoracic cavity through a thoracotomy incision for thoracic malignancies is accompanied by severe, excruciating acute postoperative pain. The objective of this study is to evaluate the efficacy of perioperative duloxetine when given as part of a multimodal analgesia in reducing the dose of opioids needed to treat acute postoperative pain after thoracotomy.


METHODS
60 patients scheduled for thoracotomy were randomly assigned to one of two treatment groups. The duloxetine group (D) received duloxetine 60 mg orally two hours before the surgical procedure and 24 hours after surgery, and the placebo group (P) received oral equivalent placebo capsules during the same time schedule. The primary outcome was the postoperative consumption of narcotics. Secondary outcome measures were assessment of postoperative pain scores (VAS) during rest, walking and coughing ,hemodynamic variables and development of any side effects.


RESULTS
Total dose of morphine needed to treat postoperative pain in first 48 hours, intraoperative isoflurane concentrations, intra and postoperative epidural infusion rates all were significantly lower in group D (P < 0.001). Postoperative pain at rest (VAS-R) was significantly less frequent in group D compared to group P at all-time intervals so as during walking (VAS-W) (P < 0.001). While during cough (VAS-C), it was comparable at all time point except at 12 hrs which was significantly low in group D (P < 0.001) . The intra, postoperative mean blood pressure and development of side effects were comparable between the two groups.


CONCLUSIONS
Oral duloxetine used peri-operatively during thoracic surgery may play an important role as multimodal analgesia for acute postoperative pain without any added side effects.