Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal

Detalhes bibliográficos
Autor(a) principal: Castro-Alves, Lucas Jorge Santana de [UNESP]
Data de Publicação: 2016
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://hdl.handle.net/11449/136477
Resumo: Background. Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy. Methods. The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results. Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4–20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0–5) mg IV morphine compared with 5.5 (0.5–9) mg IV morphine (P = 0.004). Nausea, vomiting, and time to postanesthesia care unit discharge were not significantly reduced in the duloxetine group compared with placebo. Conclusions. Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.
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spelling Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominalPerioperative duloxetine to improve operative recovery after abdominal hysterectomy: a prospective, handomized, double-blinded placebo-controlled studyHysterectomyRecoveryQualityWomenDuloxetineDuloxetinaHisterectomiaRecuperaçãoQualidadeMulheresBackground. Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy. Methods. The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results. Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4–20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0–5) mg IV morphine compared with 5.5 (0.5–9) mg IV morphine (P = 0.004). Nausea, vomiting, and time to postanesthesia care unit discharge were not significantly reduced in the duloxetine group compared with placebo. Conclusions. Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.RESUMO Introdução. A qualidade de recuperação pós-operatória é pior em pacientes do sexo feminino quando comparado ao sexo masculino. A duloxetina vem sendo usada com sucesso no tratamento da dor crônica, mas para dor aguda existe apenas um estudo. Ainda mais importante é avaliar se a duloxetina é capaz de melhorar a qualidade global de recuperação pós-operatória. O principal objetivo do presente estudo foi avaliar o efeito da duloxetina perioperatória na qualidade da recuperação pós-operatória em mulheres submetidas à histerectomia abdominal. Métodos. O estudo realizado foi prospectivo, randomizado, duplo-cego e placebo controlado. Pacientes do sexo feminino submetidas à histerectomia abdominal foram randomizadas para receber duloxetina (60 mg por via oral 2 horas antes da cirurgia e 24 horas após a cirurgia) ou uma pílula idêntica de placebo. O desfecho primário foi a pontuação do QoR-40 (Quality of Recovery- 40) em 24 horas. Dor e o consumo de opioides foram os desfechos secundários. Um valor de P <0,05 foi utilizado para anular o erro de tipo I. Resultados. Setenta pacientes foram recrutadas, e 63 completaram o estudo. A diferença média (intervalo de confiaça-95%) na recuperação global QoR-40 (Quality of Recovery-40), entre a a duloxetina e o grupo do placebo em 24 horas era de 9 (4–20) (P < 0.001). O consumo total de opioides foi reduzida em 24 horas no grupo de duloxetina em comparação com o grupo placebo, mediana (intervalo interquartil) de 1 (0-5) mg de morfina EV em comparação com 5,5 (0,5-9) mg de morfina EV (P = 0,004). Náuseas, vômitos e tempo de alta da unidade de cuidados pós-anestésica não foram significativamente reduzidos no grupo duloxetina em comparação com placebo. Conclusões. A duloxetina melhora a qualidade de recuperação pós-operatória em histerectomia abdominal. Além disso, duloxetina reduz o consumo de opioide no pós-operatório mesmo com uma analgesia pós-operatória vi multimodal. A duloxetina parece ser uma estratégia farmacológica viável para melhorar a qualidade de recuperação pós-operatória em pacientes submetidas a histerectomia abdominal.Universidade Estadual Paulista (Unesp)Módolo, Norma Sueli Pinheiro [UNESP]Universidade Estadual Paulista (Unesp)Castro-Alves, Lucas Jorge Santana de [UNESP]2016-03-31T19:22:22Z2016-03-31T19:22:22Z2016-02-19info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://hdl.handle.net/11449/13647700087024833004064076P68223546475724058porinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESP2024-09-02T15:20:03Zoai:repositorio.unesp.br:11449/136477Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestrepositoriounesp@unesp.bropendoar:29462024-09-02T15:20:03Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
Perioperative duloxetine to improve operative recovery after abdominal hysterectomy: a prospective, handomized, double-blinded placebo-controlled study
title Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
spellingShingle Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
Castro-Alves, Lucas Jorge Santana de [UNESP]
Hysterectomy
Recovery
Quality
Women
Duloxetine
Duloxetina
Histerectomia
Recuperação
Qualidade
Mulheres
title_short Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
title_full Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
title_fullStr Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
title_full_unstemmed Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
title_sort Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal
author Castro-Alves, Lucas Jorge Santana de [UNESP]
author_facet Castro-Alves, Lucas Jorge Santana de [UNESP]
author_role author
dc.contributor.none.fl_str_mv Módolo, Norma Sueli Pinheiro [UNESP]
Universidade Estadual Paulista (Unesp)
dc.contributor.author.fl_str_mv Castro-Alves, Lucas Jorge Santana de [UNESP]
dc.subject.por.fl_str_mv Hysterectomy
Recovery
Quality
Women
Duloxetine
Duloxetina
Histerectomia
Recuperação
Qualidade
Mulheres
topic Hysterectomy
Recovery
Quality
Women
Duloxetine
Duloxetina
Histerectomia
Recuperação
Qualidade
Mulheres
description Background. Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy. Methods. The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results. Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4–20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0–5) mg IV morphine compared with 5.5 (0.5–9) mg IV morphine (P = 0.004). Nausea, vomiting, and time to postanesthesia care unit discharge were not significantly reduced in the duloxetine group compared with placebo. Conclusions. Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.
publishDate 2016
dc.date.none.fl_str_mv 2016-03-31T19:22:22Z
2016-03-31T19:22:22Z
2016-02-19
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dc.publisher.none.fl_str_mv Universidade Estadual Paulista (Unesp)
publisher.none.fl_str_mv Universidade Estadual Paulista (Unesp)
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
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reponame_str Repositório Institucional da UNESP
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