Post-operative Pain Control after Knee Replacement

Postoperative pain control is a critical component of comprehensive postsurgical patient care, as it affects patient satisfaction and operative outcomes and can result in pathophysiologic neural alterations that evolve into chronic pain syndromes. Tissue trauma resulting from surgery is thought to lead to both central and peripheral nerve sensitization, resulting in an activity-dependent increase in spinal neurons excitation and a decreased threshold of nociceptive afferents, respectively. 

Historically, opioids have been the preferred drug of choice for the management of postoperative pain following joint arthroplasty. However, when used in excess, opioids can lead to deleterious side effects and have the potential for both addiction and abuse. These risks are particularly important in orthopaedics given that orthopaedic surgeons are highest prescribers amongst all surgeons.

Considering the concerns surrounding excessive opioid use, multimodal analgesic regimens utilizing a combination of opioid and nonopioid analgesic drugs targeting different sites within the central and peripheral nervous system have emerged as the new standard in managing postoperative pain. Among commonly used interventions, such as acetaminophen and nonsteroidal anti-inflammatory drugs, there is a growing body of evidence suggesting that duloxetine is used in the management of postoperative pain. The 60mg concentration of Duloxetine significantly reduced pain at rest and at movement as well as opioid consumption at 48 and 72hrs after Knee or Hip Replacement operations.

Reference:
Jones IA, Talehakimi A, Murphy LS, Wang JC, Piple AS, Christ AB, et al. Duloxetine for postoperative pain control following knee or hip replacement: A systematic review and meta-analysis. Arthroplasty Today. 2023 Apr;20:101097. doi:10.1016/j.artd.2023.101097