Introduction

Central Sensitization has been known to cause persistent pain and dissatisfaction after Total Knee Arthroplasty (TKA). CS is also closely related to the increase in wound complication after TKA. Duloxetine provide the improved pain control and has the potential aid in wound healing after TKA in patients with CS. The purpose of this study is to determine whether preemptive duloxetine in patients with CS is effective for acute postoperative pain control and wound healing following TKA.

Method

CS was defined as a group with a score of 40 or higher through Central Sensitization Inventory (CSI) survey. Patients were randomly assigned to either the duloxetine group or the placebo group 2 weeks before surgery. The duloxetine group took duloxetine 30mg once a day from 2 weeks before surgery to 8 weeks after surgery, and the placebo group took placebo once a day. Pain Visual Analogue Scale (VAS) were measured at preoperatively, postoperative 1 day, 3, 5, 7 days and 2, 6, 12 weeks. Brief Pain Inventory (BPI) were also examined preoperatively and postoperatively. All wound complication, the temperature of the surgical site and adverse events were investigated.

Results

During the 12-week postoperative period, the duloxetine group had significantly lower resting, walking, nighttime and average pain VAS than the placebo group (all p < 0.05). BPI interference also showed significantly superior results in the duloxetine group compared to the placebo group at 2,6,12 weeks after surgery (all p < 0.05). The rate of wound complication was significantly lower in duloxetine group (p < 0.05). Changes in wound temperature through the thermal imaging camera also showed a significant difference during follow-up period (all p < 0.05).

Conclusion

Preemptive duloxetine is effective in reducing pain and wound healing immediately after surgery in central sensitized patients who are performing TKA.