Efficacy of perioperative duloxetine on acute and chronic post mastectomy pain

Abstract EN

Objectives Acute postoperative pain following radical mastectomy has been shown to increase the risk for chronic postmastectomy pain, a type of neuropathic pain.

Preemptive analgesia has been shown to be effective in reducing the incidence of some types of neuropathic pain.

We investigated the analgesic efficacy of duloxetine on acute and chronic pain in patients undergoing breast surgery.

Materials and methods Fifty patients scheduled for radical mastectomy with axillary dissection were randomized in a double-blinded manner to receive either duloxetine 60 mg (group D) starting 2 days before operation for 2 weeks followed by 30 mg until the end of study or placebo capsules (group P) for the same course.

Total morphine consumption over the first 48 h, time to first rescue analgesic, and pain scores were recorded [visual analog scale (VAS)] at 2, 4, 12, and 24 h postoperatively, daily until the fourth day, then 3 and 6 months later.

Results In the duloxetine group compared with the placebo group, total morphine consumption was less (at 24 h, 14 ± 2.3 vs.

24 ± 1.7 and at 48 h, 11.5 ± 2.5 vs.

20 ± 1.4, P < 0.001, respectively), time to first rescue analgesic was longer (4.6 ± 0.7 h vs.

2.5 ± 0.5 h, P < 0.001, respectively), with significant decrease in VAS scores of pain at all time points (P < 0.001), and the incidence of pain was less at 3- and 6-month follow-up.

Conclusion Duloxetine significantly reduced postoperative analgesic requirements, VAS, and incidence of chronic pain at 3- and 6-month follow-up in women undergoing breast surgery.