Patients who have symptoms of depression and are undergoing total hip arthroplasty may benefit from short-term duloxetine therapy, according to results of a randomized controlled trial published in The Journal of Arthroplasty.
Patients (N=67) undergoing unilateral total hip arthroplasty at the West China Hospital between 2021 and 2022 and who had preoperative 17-item Hamilton Depression Scale (HAM-D) scores of 8 or greater were randomly assigned in a 1:1 ratio to receive duloxetine 60 mg (n=34) or placebo (n=33) for 7 days starting 2 hours prior to surgery. The primary outcomes were postoperative pain as assessed by visual analog scale (VAS), morphine consumption, and hip function.
The mean ages of patients in the intervention and control arms were 58 (range, 28-79) and 61 (range, 38-78) years, mean body mass index (BMI) values were 23.8 (range, 17.0-31.2) and 23.6 (range, 16.9-33.0) kg/m2, and mean HAM-D scores were 11.5 (range, 9-13) and 11 (range, 9-14), respectively.
Starting at day 3, recipients of duloxetine reported significantly lower walking pain scores than individuals receiving placebo (mean, 4.0 vs 5.1; P =.003), respectively. The significant group differences continued through weeks 1 (mean, 2.6 vs 4.2; P <.001), 2 (mean, 1.9 vs 3.2; P =.001), and 3 (mean, 1.8 vs 2.5; P =.031), respectively. The groups reported similar levels of pain at weeks 6 and 12.
Walking pain scores were significantly correlated with preoperative HAM-D scores among individuals receiving placebo (r, 0.356; P =.042) but not among those receiving duloxetine (r, 0.005; P =.977).
Similar trends were observed for VAS scores during hip flexion and at rest, with duloxetine being associated with significantly decreased pain scores from day 3 to week 3 (all P ≤.016) and from day 3 to week 2 (all P ≤.004), respectively.
Patients in the duloxetine cohort consumed less morphine at day 3 (mean, 10.0 vs 20.0 mg; P =.002) and week 3 (mean, 10.0 vs 25.0 mg; P =.002) compared with those in the placebo cohort, respectively.
Compared with placebo, duloxetine was associated with greater flexion at day 3 (P =.002) and week 3 (P =.003), abduction at week 3 (P =.013), and Harris Hip Score at week 3 (P =.015), and lower Western Ontario and McMaster Universities Osteoarthritis Index scores at week 3 (P =.012). No functional differences were observed at week 12.
Length of hospital stay was numerically shorter among patients receiving duloxetine (mean, 3.0 days) compared with those receiving placebo (mean, 3.4 days); however, this finding was not significant (P =.331).
Safety profiles were similar between treatment groups. The most common adverse events reported included nausea and vomiting (17.6% vs 39.4%; P =.048), somnolence (17.6% vs 9.1%), fatigue (14.7% vs 12.1%), dizziness (12.1% vs 11.8%), constipation (11.8% vs 6.1%), and pruritus (5.9% vs 12.1%) among patients receiving duloxetine vs placebo, respectively.
These data indicate that short-term duloxetine treatment demonstrated a significant analgesic benefit among patients with symptoms of depression who underwent total hip arthroplasty. The study authors conclude, “Incorporation of duloxetine into the current multimodal analgesic protocol in patients who have depressive symptoms may optimize postoperative pain control for this high-risk population.”
This article originally appeared on Clinical Pain Advisor
Ding Z-C, Li H, Huang C, et al. Significant analgesic benefits of perioperative duloxetine in patients who have depressive symptoms undergoing total hip arthroplasty: a randomized controlled trial. J Arthroplasty. Published online October 14, 2022. doi:10.1016/j.arth.2022.10.007