Serotonin norepinephrine reuptake inhibitors in managing neuropathic pain following spinal and non-spinal surgery: A systematic review and meta-analysis of randomized controlled trials.
Clin Neurol Neurosurg
; 239: 108223, 2024 Apr.
Article
em En
| MEDLINE
| ID: mdl-38484604
ABSTRACT
BACKGROUND:
While serotonin norepinephrine reuptake inhibitors (SNRIs) offer promise in managing Post-surgical neuropathic pain (PSNP), uncertainties remain. This study aims to evaluate the effectiveness and adverse events of SNRIs in managing PSNP.METHODS:
Systematic searches of PubMed, Embase, and Cochrane databases up to January 1st 2023 identified randomized controlled trials (RCTs) comparing SNRIs to placebo for PSNP. The primary outcome measures were pain at rest and adverse events post-surgery. Subgroup analyses were conducted based on surgical type and specific SNRIs.RESULTS:
A total of 19 RCTs, encompassing 1440 participants (719 in the SNRI group vs 721 in the placebo group), met the inclusion criteria and were included. The pooled results demonstrated that pain scores were significantly lower in patients treated with SNRIs at 2â¯hours (MD-0.26; 95%CI -0.47 to -0.04; p=0.02), 6â¯hours (MD-0.68; 95%CI -1.01 to -0.34; p<0.0001), 24â¯hours (MD-0.54; 95%CI -0.99 to -0.09; p=0.02), and 48â¯hours (MD-0.66; 95%CI -1.23 to -0.10; p=0.02) post-surgery. In terms of adverse events, dizziness (OR2.53; 95%CI 1.34-4.78; p=0.004) and dry mouth (OR2.21; 95%CI 1.25-3.92; p=0.007) were significantly higher in the SNRIs group. Subgroup analysis showed that SNRI was found to significantly lower the 24-hour pain score after spinal surgery (MD-0.45; 95%CI -0.84 to -0.05; p=0.03). Duloxetine (MD-0.63; 95%CI -1.15 to -0.11; p=0.02) had a significant effect in lowering the 24-hour pain score at rest compared to placebo, whereas venlafaxine did not.CONCLUSIONS:
SNRIs yielded considerable pain score reductions across multiple post-surgical intervals, although accompanied by an increased incidence of dizziness and dry mouth.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Dor Pós-Operatória
/
Ensaios Clínicos Controlados Aleatórios como Assunto
/
Inibidores da Recaptação de Serotonina e Norepinefrina
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Neuralgia
Limite:
Humans
Idioma:
En
Revista:
Clin Neurol Neurosurg
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Indonésia