الفهرس 
PainOnly 14 pages are availabe for public view
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Abstract
Prevention and treatment of postoperative pain continue to be a major challenge in postoperative care and plays an important role in the early mobilization and wellbeing of the surgical patient. (’) Traditionally, the pathophysiology and treatment of postoperative pain and neuropathic pain have been considered as separate and distinct. Spinal anesthesia is intended to minimize the sense of pain for a patient. In addition to making the surgical experience less traumatic, anesthesia also appears to promote healing, since pain interferes with the rapid healing of injuries. A number of different anesthesia drugs are available, along with a variety of techniques to maximize effectiveness. Spinal anesthesia is a common technique for procedures involving the lower body. Morphine is the preferred drug for relieving pain in the immediate postoperative period. However, there is great inter patient variability in the efficient dosing of morphine and it is still difficult to precisely adapt dosing to the patient’s needs. Duloxetine is a selective SNRI that is prescribed for treatment of depression and anxiety disorders. It is also efficacious in treating pain in diabetic neuropathy and fibromyalgia. The mechanism of its analgesic action could be explained by a combined central and peripheral pain modulating role through the effect of serotonin and norepinephrine on descending inhibitory pain pathways in the brain and spinal cord and activation of some cerebral prefrontal areas. Also, it has an antinociceptive effect through Na+ channel blocks with anti-hyperalgesic effects through the inhibition of the neuronal cell firing resulting from peripheral injury.(113) Therefore, duloxetine has a great role in management of neuropathic pain and reducing postoperative pain. In addition, it may improve the depression and anxiety that are common during the perioperative period. The aim of this study was to evaluate the efficacy of preoperative duloxetine on the duration of spinal anesthesia, severity of postoperative pain, and total analgesic consumption. This prospective, randomized, double-blind study was carried on sixty patients, ASA I &II, admitted to Tanta University Hospital in orthopedic surgery department for elective hip joint surgery. An informed consent was taken from all the patients Patients classified into two groups: P group D: 30 patients received duloxetine 60 mg on two divided doses 30 mg every 12 h for three days before the operation, 2 h preoperative and 12 h after the surgery P group C: 30 patients received placebo capsules by the same way as duloxetine group. The inclusion criteria: of the patients in this study were: Patients of American society of Anesthesiologists physical status (ASA) 1- 11, aged between 18 and 60 years and scheduled to undergo hip surgery. Exclusion criteria were: Patient refusal, Patients with known hypersensitivity to duloxetine, Psychiatric patients especially in combination with MAOIs, uncontrolled narrow-angle glaucoma history of chronic pain, and regular medication with SNRI or analgesic (excluding acetaminophen and non-steroidal antiinflammatory drugs),Patients with any hepatic insufficiency or patients with end-stage renal disease (requiring dialysis) or severe renal impairment (creatinine clearance <30ml) and patients with uncontrolled hypertension. All the patients were monitored during the operation for vital signs (heart rate and mean arterial blood pressure), duration of spinal anesthesia, postoperative pain (using 10 point visual analogue scale (VAS) where (0) no pain and (10) most intense pain) were measured in both groups 0, 2, 6, 12, 24 &48 hours after operation, first rescue and total analgesic consumption, level of sedation and side effects were monitored. Our result showed that preoperative administration of oral duloxetine significantly decreases post-operative pain and total analgesic consumption and improve patient psychology with significant reduction in associated side effects.