Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

Perioperative Duloxetine and Etoricoxibto improve postoperative pain after lumbar Laminectomy: a randomized, double-blind, controlled study

Authors: Josef Zekry Attia, Haidy Salah Mansour

Published in: BMC Anesthesiology | Issue 1/2017

Login to get access

Abstract

Background

Duloxetine, Etoricoxib and opioid are of the commonly administered drugs in Lumbar laminectomy. The aim of this study is to assess the effect of perioperative use of Duloxetine in combination with Etoricoxib on postoperative pain and opioid requirements.

Methods

One hundred twenty patients with ASA physical status were enrolled with age between 18 and 70 years. Patients were divided randomly into four groups of 30 patients: group P received placebo, group E received etoricoxib 120 mg, group D received duloxetine 60 mg and group D/E received duloxetine 60 mg capsules and etoricoxib 120 mg; 1 h before surgery and 24 h after.

Results

Neither Duloxetine nor etoricoxib individually had effect on pain with movement, while their combination revealed a significant reduction in pain scores over the entire postoperative period at rest and on movement. Etoricoxib showed a significant decrease in pain at all times at rest when compared with group P, while it showed significant pain decrease only at 0, 2 and 4 h when compared with group D. On the other hand duloxetine alone showed significant decrease in pain at rest at 24 h and 48 h when compared with group P. ConcerningMorphine requirement after 24 h.; it wassignificantly lower in the D/E group in comparison with groups P, E and D. It should be noted also that there was a significant decrease morphine requirement in both groups E and D.

Conclusion

The perioperative administration of the combination of etoricoxib and duloxetine improved analgesia and reduced opioid consumption without significant side effects.

Trial registration

ISRCTN48329522. 17 June 2017
Literature
1.
2.
Kehlet H, Dahl JB. The value of" multimodal" or" balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77(5):1048–56.CrossRefPubMed
3.
Management ASoATFoAP. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on acute pain management. Anesthesiology. 2012;116(2):248.CrossRef
4.
Tallarida RJ. Drug synergism: its detection and applications. J Pharmacol Exp Ther. 2001;298(3):865–72.PubMed
5.
Jones CK, Peters SC, Shannon HE. Efficacy of duloxetine, a potent and balanced serotonergic and noradrenergic reuptake inhibitor, in inflammatory and acute pain models in rodents. J Pharmacol Exp Ther. 2005;312(2):726–32.CrossRefPubMed
6.
Lunn MPT, Hughes RAC, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;1
7.
Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Int Med. 2004;140(6):441–51.CrossRefPubMed
8.
9.
Nasr DA. Efficacy of perioperative duloxetine on acute and chronic postmastectomy pain. Ain-Shams J Anaesth. 2014;7(2):129.CrossRef
10.
Castro-Alves LJ, de Medeiros A, Neves SP, de Albuquerque CLC, Modolo NS, De Azevedo VL, et al. Perioperative Duloxetine to improve postoperative recovery after abdominal hysterectomy: a prospective, randomized, double-blinded, placebo-controlled study. Anesth Analg. 2016;122(1):98–104.CrossRefPubMed
11.
Bedin A, Bedin RAC, Vieira JE, Ashmawi HA. Duloxetine as an analgesic reduces Opioid consumption after spine surgery: a randomized, double-blind, controlled study. Clin J Pain. 2017;33(10):865–9.CrossRefPubMed
12.
Goldstein DJ, Lu Y, Detke MJ, Lee TC, Iyengar S. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain. 2005;116(1):109–18.CrossRefPubMed
13.
Derry S, Moore RA. Single dose oral celecoxib for acute postoperative pain in adult, Cochrance Database of Systemic Review 2013;22(10). Issue 3. Art. No: CD004233. doi:10.​1002/​14651858.​cd004233. pub 4.
14.
White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5S):S5–S22.CrossRefPubMed
15.
Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Endocrinol. 2010;24(2):121–32.CrossRef
16.
17.
Sinatra RS, Shen QJ, Halaszynski T, Luther MA, Shaheen Y. Preoperative rofecoxib oral suspension as an analgesic adjunct after lower abdominal surgery: the effects on effort-dependent pain and pulmonary function. Anesth Analg. 2004;98(1):135–40.CrossRefPubMed
18.
Rasmussen GL, Malmstrom K, Bourne MH, Jove M, Rhondeau SM, Kotey P, et al. Etoricoxib provides analgesic efficacy to patients after knee or hip replacement surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg. 2005;101(4):1104–11.CrossRefPubMed
19.
Puura A, Puolakka P, Rorarius M, Salmelin R, Lindgren L. Etoricoxib pre-medication for post-operative pain after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2006;50(6):688–93.CrossRefPubMed
20.
Clark R, Derry S, Moore RA. Single dose oral etoricoxib for acute postoperative pain in adult. The Cocharance Database Systemic Reviews. 2012;18(4):CD004309. doi:10.​1002/​14651858.​CD004309. pub 3.
21.
Agrawal NG, Porras AG, Matthews CZ, Woolf EJ, Miller JL, Mukhopadhyay S, et al. Dose proportionality of oral etoricoxib, a highly selective cyclooxygenase-2 inhibitor, in healthy volunteers. J Clin Pharmacol. 2001;41(10):1106–10.CrossRefPubMed
22.
Liu W, Loo C, Chiu J, Tan H, Ren H, Lim Y. Analgesic efficacy of pre-operative etoricoxib for termination of pregnancy in an ambulatory centre. Singap Med J. 2005;46(8):397.
23.
Lierz P, Losch H, Felleiter P. Evaluation of a single preoperative dose of etoricoxib for postoperative pain relief in therapeutic knee arthroscopy: a randomized trial. Acta Orthop. 2012;83(6):642–7.CrossRefPubMedPubMedCentral
24.
Sun Y-H, Dong Y-L, Wang Y-T, Zhao G-L, Lu G-J, Yang J, et al. Synergistic analgesia of duloxetine and celecoxib in the mouse formalin test: a combination analysis. PLoS One. 2013;8(10):e76603.CrossRefPubMedPubMedCentral
25.
Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003;10(4):390–2.CrossRefPubMed
26.
Myles P, Wengritzky R. Simplified postoperative nausea and vomiting impact scale for audit and post-discharge review. Br J Anaesth. 2012;108(3):423–9.CrossRefPubMed
27.
Happich M, Schneider E, Boess FG, Wilhelm S, Schacht A, Birklein F, et al. Effectiveness of duloxetine compared with pregabalin and gabapentin in diabetic peripheral neuropathic pain: results from a German observational study. Clin J Pain. 2014;30(10):875–85.CrossRefPubMed
28.
Onuţu AH. Duloxetine, an antidepressant with analgesic properties–a preliminary analysis. Rom J Anaesth Intensive Care. 2015;22(2):123–8.PubMedPubMedCentral
29.
Basbaum AI, Fields HL. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Annu Rev Neurosci. 1984;7(1):309–38.CrossRefPubMed
30.
Wang S-Y, Calderon J, Wang GK. Block of neuronal Na+ channels by antidepressant duloxetine in a state-dependent manner. J Am Soc Anesth. 2010;113(3):655–65.
31.
Nakajima K, Obata H, Iriuchijima N, Saito S. An increase in spinal cord noradrenaline is a major contributor to the antihyperalgesic effect of antidepressants after peripheral nerve injury in the rat. Pain. 2012;153(5):990–7.CrossRefPubMed
32.
Biddiss E, Knibbe TJ, McPherson A. The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces: a systematic review of randomized and nonrandomized trials. Anesth Analg. 2014;119(2):433–48.CrossRefPubMed
33.
Kehlet H. Postoperative Opioid sparing to hasten RecoveryWhat are the issues? J Am Soc Anesthesiol. 2005;102(6):1083–5.CrossRef
34.
Recla JM. New and emerging therapeutic agents for the treatment of fibromyalgia: an update. J Pain Res. 2010;3(89-103):b4.
35.
Rawal N, Viscusi E, Peloso PM, Minkowitz HS, Chen L, Shah S, et al. Evaluation of etoricoxib in patients undergoing total knee replacement surgery in a double-blind, randomized controlled trial. BMC Musculoskelet Disord. 2013;14(1):300.CrossRefPubMedPubMedCentral
36.
Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3(3):159–80.CrossRefPubMed
37.
YaDeau JT, Brummett CM, Mayman DJ, Lin Y, Goytizolo EA, Padgett DE, et al. Duloxetine and subacute pain after knee Arthroplasty when added to a multimodal analgesic RegimenA randomized, placebo-controlled, triple-blinded trial. J Am Soci Anesth. 2016;125(3):561–72.
38.
Lehmann TR, LaROCCA HS. Repeat lumbar surgery: a review of patients with failure from previous lumbar surgery treated by Spinal Canal exploration and lumbar spinal fusion. Spine. 1981;6(6):615–9.CrossRefPubMed
Metadata
Title
Perioperative Duloxetine and Etoricoxibto improve postoperative pain after lumbar Laminectomy: a randomized, double-blind, controlled study
Authors
Josef Zekry Attia
Haidy Salah Mansour
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0450-z

Other articles of this Issue 1/2017

BMC Anesthesiology 1/2017 Go to the issue

Research article

Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study

Research article

Capnography sensor use is associated with reduction of adverse outcomes during gastrointestinal endoscopic procedures with sedation administration

Research article

Effects and mechanism of dexmedetomidine on neuronal cell injury induced by hypoxia-ischemia

Research article

Levosimendan combined with epinephrine improves rescue outcomes in a rat model of lipid-based resuscitation from bupivacaine-induced cardiac arrest

Research article

Assessment of perioperative minute ventilation in obese versus non-obese patients with a non-invasive respiratory volume monitor

Research article

A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil