Background and Aims Chronic residual pain after total knee arthroplasty (TKA) is one of the challenges of postoperative pain management. Duloxetine in controlling neuropathic pain and pregabalin by affecting nociceptors can be effective in postoperative pain management. The aim of this study is to compare the effect of perioperative oral duloxetine and pregabalin in pain management after knee arthroplasty.

Methods In this clinical trial, 90 patients scheduled for TKA under spinal anesthesia were randomly assigned to one of three groups A (Pregabalin 75 mg), B (Duloxetine 30 mg), and C (Placebo). Drugs were administered 90 minutes before, 12 and 24 hours after surgery. Visual analog pain score (VAS), the first analgesic request time, postoperative analgesic consumption (i.v. paracetamol), and WOMAC score six months after surgery were recorded.

Results VAS score and analgesic consumption 48 hours after TKA in groups A and B had a significant decrease compared to placebo (p<0.05). The first analgesic request time in groups A and B was longer than the group C (p<0.05). Of note, while the differences were statistically significant, they are most likely not clinically significant. The WOMAC score before and 6 months after the arthroplasty did not differ between the groups (p>0.05).

Conclusions Perioperative oral pregabalin and duloxetine similarly reduces pain and the need for analgesic consumption within 48 hours after TKA, but has no effect on knee mobility status.