Pregabalin and Duloxetine versus Celecoxib in Pain Control after Total Knee Arthroplasty. A Randomized Controlled Trial

Background: Total knee arthroplasty (TKA) is the terminal therapy for knee osteoarthritis (KOA). Long-term postoperative pain is the major complaint in TKA surgery. Nonsteroidal inflammatory drugs (NSAIDs), as the common medicine to treat long-term postoperative pain, have unsatisfactory analgesic effects. Pregabalin and duloxetine work as analgesia medicines, and their exact efficacy on long-term pain after TKA remains elusive. Methods This is a monocentral, open-label randomized clinical trial. KOA participants aged above 50 years old with surgical plans were recruited in January 2022. Eligible participants were randomized 1:1:1 to the standard, pregabalin, and duloxetine groups through a computer dynamic randomization approach. After TKA, the involved participants received study medicine according to their group and were measured 2, 4, and 12 weeks after the start of the study medicine treatment. Results In week 2, there were significant differences in the pressure pain thresholds (PPTs) of the operated knee (P < 0.001) among the three groups. At week 4, there were significant differences in visual pain score (VAS) (P < 0.001), operated knee PPTs (P < 0.001), and hospital for special surgery (HSS) score (P = 0.010) among the three groups. At week 12, there were significant differences in the operated knee PPTs (P < 0.001) and HSS scores (P = 0.009) among the three groups. Five participants in the duloxetine group and 2 participants in the standard group reported AEs. Conclusions Pregabalin and duloxetine were able to reduce both pain and pain sensitivity and improve joint function after TKA compared with celecoxib. Clinical trial registration No. ChiCTR2200056163.