Antidepressant useful in pain management following abdominal cancer surgery

Administering a single dose of the serotonin and norepinephrine reuptake inhibitor (SNRI) duloxetine prior to a major abdominal cancer surgery leads to lower postoperative pain, reduced opioid requirement, and better quality of recovery, according to a study.

A total of 62 patients undergoing major abdominal cancer surgery were randomized to receive either oral duloxetine 60 mg or placebo. Treatment was administered 2 hours prior to the operation. Outcomes included postoperative 48 hours morphine consumption, visual analogue scale (VAS) pain score, and quality of recovery.

Results showed that the cumulative 48 hours morphine consumption was significantly lower among duloxetine-treated patients than among those who received placebo (mean, 5.2 vs 12.9 mg; difference, 7.6 mg, 95 percent confidence interval, 5.9–9.3; p<0.001).

Accordingly, the time to first morphine request was much longer in the duloxetine group (median, 25 hours, range 19–38 vs 8 hours, range, 4–9; p<0.001).

Compared with placebo, duloxetine treatment resulted in lower pain scores at postoperative hours 8, 12, 16, and 24. The pain scores did not differ between the two treatment groups at the following time points: immediately after the surgery and postoperative hours 2, 4, 36, and 48.

Finally, the quality of recovery was a lot better among patients in the duloxetine vs the placebo group. The median global QoR-40 scores were 185 and 170, respectively (p<0.001).