Troels H Lunn1, Vibe G Frokjaer, Torben B Hansen, Per W Kristensen, Thomas Lind, Henrik Kehlet. 1. From the Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark (T.H.L.); The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark (T.H.L., T.B.H., P.W.K., T.L., H.K.); Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (V.G.F.); University Clinic for Hand, Hip and Knee Surgery, Holstebro Hospital, Aarhus University, Aarhus, Denmark (T.B.H.); Department of Orthopedic Surgery, Section for Hip and Knee Replacement, Vejle Hospital, Vejle, Denmark (P.W.K.); Department of Orthopedic Surgery, Copenhagen University Hospital, Gentofte, Denmark (T.L.); and Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (H.K.).
Abstract
BACKGROUND: Sufficient pain treatment remains a challenge after total knee arthroplasty (TKA), especially in high pain catastrophizing patients. Serotonergic signaling may be involved in pain processing, but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. METHODS: A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. RESULTS:Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being -5 (-13 to 3), P = 0.20. Overall pain upon ambulation and at rest from days 2 to 6 was lower in the escitalopram versus placebo group, as was depression score at day 6 (all P ≤ 0.01 in analyses uncorrected for multiple tests). Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group. No other between-group differences were observed. CONCLUSIONS: Escitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients. Future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.
RCT Entities:
BACKGROUND: Sufficient pain treatment remains a challenge after total knee arthroplasty (TKA), especially in high pain catastrophizing patients. Serotonergic signaling may be involved in pain processing, but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. METHODS: A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. RESULTS:Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being -5 (-13 to 3), P = 0.20. Overall pain upon ambulation and at rest from days 2 to 6 was lower in the escitalopram versus placebo group, as was depression score at day 6 (all P ≤ 0.01 in analyses uncorrected for multiple tests). Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group. No other between-group differences were observed. CONCLUSIONS:Escitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients. Future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.
Authors: Albert T Anastasio; Kevin X Farley; Scott D Boden; Thomas L Bradbury; Ajay Premkumar; Michael B Gottschalk Journal: J Arthroplasty Date: 2019-08-08 Impact factor: 4.757
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Authors: Niklas I Nielsen; Henrik Kehlet; Kirill Gromov; Anders Troelsen; Henrik Husted; Claus Varnum; Per Kjærsgaard-Andersen; Lasse E Rasmussen; Lina Pleckaitiene; Nicolai B Foss Journal: Br J Anaesth Date: 2021-11-05 Impact factor: 9.166