Reachout Orthopedics - Issue 2

P ostoperative pain is mediated by different mechanisms at multiple neural sites. Thus, multimodal analgesics can reduce the post- operative pain [1]. Although Opioids are considered the analgesics of choice to treat moderate to severe pain, their use carries the risk of side effects and hyperalgesia [2]. Multimodal analgesia can be achieved by combining different analgesics and different methods of administration, to provide better analgesia synergistically compared with con- ventional analgesia [3]. Therefore, lower doses for each drug can be provided with fewer overall side-effects obtained from individual compounds [4]. Recently, antidepressants such as dulox- etine, a selective serotonin and norepineph- rine reuptake inhibitor (SSNRI), have accom- plished pain relief in persistent and chronic pain as in fibromyalgia, postherpetic neural- gia, diabetic neuropathy [5], osteoarthritis and musculoskeletal pain [6]. The analgesic effect of duloxetine is attributed to its ability to enhance both serotonin and norepinephrine neurotransmission in descending inhibitory pain pathways. [7]. Moreover, some studies have promoted its use to improve the quality of recovery after surgery and reduce the acute postoperative pain after knee replacement surgery [8], mastectomy [9], hysterectomy [10], and after spine surgery [11]. In addition Josef Zekry Attia*, Haidy Salah Mansour * Correspondence: josefzekry2@yahoo.com Departments of Anesthesiology and I.C.U Al-Minia University, Faculty of Medicine, Minia University, Minia 61111, Egypt Therapeutic Update Duloxetine, Etoricoxib and opioid are of the commonly administered drugs in Lumbar laminectomy. The aim of this study is to assess the effect of perioperative use of Duloxetine in combination with Etoricoxib on postoperative pain and opioid requirements. The perioperative administration of the combination of etoricoxib and duloxetine improved analgesia and reduced opioid consumption without significant side effects. PERIOPERATIVE DULOXETINE AND ETORICOXIB TO IMPROVE POSTOPERATIVE PAIN AFTER LUMBAR LAMINECTOMY: A RANDOMIZED, DOUBLE-BLIND, CONTROLLED STUDY 12