Discussion
postoperative pain, bradycardia, cancer, pain, headache, nausea, vomiting
ADVERSE EFFECTS, CANCER
The present trial had shown that patients subjected to laparoscopic colorectal surgery who administered three perioperative duloxetine, 60 mg 12 h preoperative, a second dose one hour preoperative, and a third dose 24 h postoperative, had a significant lower postoperative morphine consumption, intraoperative fentanyl consumption, a significant decreased postoperative pain and better quality of recovery for 48 h postoperatively. The adverse effects including nausea, vomiting, bradycardia, and headache were higher in the duloxetine group compared with the placebo group; however they did not reach the statistical significant level.The unique criteria of our study that administered three perioperative doses of duloxetine instead of single or twice doses as in previous studies, more over we assess the perioperative duloxetine on the QoR. Furthermore, the nature of pain in laparoscopic surgery is different from open surgery.Unlike postoperative pain after open surgery, which is most of somatic origin, postoperative pain after laparoscopic surgery consists of both somatic and visceral elements [The improved postoperative analgesia, reduction of opioid consumption and pain intensity reported in our study is in concordance with Castro-Alves and his collegues [Moreover, in our previous [It is reasonable that if an analgesic could also provide emotional stability, it would be a better adjunct for postoperative recovery. One of the most important findings in our study was the better postoperative quality of recovery, as represented by the total score of 180.8 ± 4.5 in patients who received duloxetine compared with those who received a placebo capsule 156 ± 5.9. It specifically improved the five domains: physical comfort, independence, emotional, psychological, and pain in the quality of recovery score. This improvement in QOR is not only due to less opioid consumption and lower VAS scores but also due to a favorable effect on emotional and psychological status which are of utmost importance in cancer patients undergoing surgery.Nasr’s Also, in accordance with our study, a meta-analysis conducted by Zorrilla and partners [In contrast to our study, Erdmann and his collegues [Dose selection in this trial was inspired by our previous study [It has been proposed that duloxetine exerts its analgesic action through three different processes and locations. The dorsal horn of the spinal cord dopamine, NE, and serotonin levels are raised as a result of its action. These monoamines stimulate the spinal cord’s 5-HT