Effect of Preoperative Duloxetine on Quality of Recovery After Outpatient Laparoscopic Surgery

It has been demonstrated that female patients have poor quality of surgical recovery compared
to male patients.1 Increased sensitivity to pain and increased susceptibility to
postoperative nausea and vomiting have been attributed as causal factors.2, 3 Currently, few
strategies have been shown to improve quality of recovery in female patients undergoing
laparoscopic hysterectomy.4 A better recovery in female patients undergoing outpatient
laparoscopy is particularly desirable since those patients do not have access to potent
intravenous medications and nursing support after hospital discharge.

In addition, pain after ambulatory surgery remains an unsolved problem in The United States
and Europe.5,6 It is associated with delayed hospital discharge and it can result to an
increased opioid consumption with adverse side effects. The concept of multimodal analgesic
technique was introduced more than 15 years ago and several techniques have been studied over
the years including NSAIDs, acetaminophen, membrane stabilizers, ketamine, and local and
regional anesthetic techniques.7,8 Both serotonin and norepinephrine have involvement in
modulation of pain mechanisms in the central nervous system. Duloxetine is a selective
serotonin and norepinephrine reuptake inhibitor that has been used for mitigation of pain in
such conditions as chronic musculoskeletal pain, diabetic peripheral neuropathic pain,
post-herpetic neuralgia, and fibromyalgia.9,10 Duloxetine was also found to reduce
postoperative morphine requirements in patients undergoing knee replacement surgery.11 The
MQOR 40 is a validated instrument that was specifically design to evaluate patient recovery
after anesthesia and surgery.12 This instrument can be particularly valid to examine
interventions which affect different spheres of patient recovery as is the case of
duloxetine.

A suicidal behavior questionnaire (SBQ-R) will be used to screen for suicidal risk among
potential subjects. If any subject exhibits suicidal ideation as a result of scoring high on
the questionnaire, there surgeon and/or primary care provider will be notified by the
principal investigator.

The objective of this study is to determine the effect of preoperative duloxetine on
postoperative quality of recovery after ambulatory surgery.

Significance: Use of preoperative duloxetine may improve patient's quality of recovery,
decrease postoperative pain, opioid consumption and opioid related side effects after
ambulatory surgery.

Inclusion Criteria:

- outpatient gynecological laparoscopy

- ASA PS 1 and 2

- fluent in English

Exclusion Criteria:

- history of allergy to duloxetine, history of chronic opioid use, pregnant patients,
preoperative SSRI or SNRI use, prolonged QT interval on ECG