Perioperative Duloxetine for Persistent Postoperative Pain After Total Hip Arthroplasty: A Randomized Controlled Trial

Chronic postsurgical pain (CPSP) persists in 10 to 15% of patients after total hip arthroplasty (THA). Duloxetine provides short-term analgesic benefits, but its role in preventing CPSP remains unclear. This study evaluated whether extended perioperative duloxetine reduced CPSP at three months after THA.

In this prospective, single-center, open-label, randomized controlled trial, patients undergoing primary THA for osteoarthritis were randomized 1:1 to duloxetine plus standard care or standard care alone. Duloxetine was administered for 12 weeks, with preoperative titration to 60 mg/day, perioperative maintenance, and postoperative tapering. The primary outcome was daily average hip pain at three months, assessed using a numerical rating scale (NRS); CPSP was defined as a score ≥ 3. The secondary outcomes included the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score, Merle d'Aubigné-Postel (DAP) score, and postoperative analgesic consumption. There were 96 patients who underwent THA (duloxetine, n = 47; control, n = 49).

At three months, the median pain NRS score was 0 (interquartile range, 0 to 1) in both groups (P = 0.17), and CPSP incidence was 6.4 and 10.2%, respectively (P = 0.72). Functional outcomes favored the duloxetine group, with higher total JHEQ scores (driven by movement and mental domains) and improved DAP pain and mobility domain scores. Celecoxib consumption was lower in the duloxetine group at one and three months (P < 0.05). Duloxetine was discontinued in 21% of patients because of adverse events; none were serious.

Perioperative duloxetine did not reduce pain or CPSP incidence at three months after THA. Nevertheless, improved functional outcomes and lower analgesic use suggest a potential role in enhancing postoperative recovery. Routine use is not supported, although some patients may benefit.