Efficacy of Duloxetine Compared with Opioid for Postoperative Pain Control Following Total Knee Arthroplasty
Bibliographic record
Abstract
Abstract BackgroundOpioid is known to be effective in pain control after total knee arthroplasty (TKA). However, recently it has become a major concern due to addiction. Duloxetine, the serotonin-norepinephrine reuptake inhibitor, is effective for pain control in osteoarthritis patients. However, no study has compared the efficacy of the two for pain control after TKA. The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following TKA.MethodsAmong 857 patients, 260 (30.3%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score, and the rate over the minimum clinically significant difference (MCID) using WOMAC score) were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated.ResultsThere was no significant difference in pain VAS score, WOMAC Pain and Function score, or the rate over MCID at each time point between before and after surgery (all p > 0.05). Fifteen (11.0%) patients in the opioid group and six (4.8%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p > 0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p > 0.05).ConclusionDuloxetine has a similar effect to opioid on postoperative pain control. Thus, duloxetine can be considered as an alternative to opioid for postoperative pain control following TKA.Level of evidence:Therapeutic study Level Ⅳ.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".