• Troels H Lunn, Vibe G Frokjaer, Torben B Hansen, Per W Kristensen, Thomas Lind, and Henrik Kehlet.
• From the Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark (T.H.L.); The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark (T.H.L., T.B.H., P.W.K., T.L., H.K.); Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (V.G.F.); University Clinic for Hand, Hip and Knee Surgery, Holstebro Hospital, Aarhus University, Aarhus, Denmark (T.B.H.); Department of Orthopedic Surgery, Section for Hip and Knee Replacement, Vejle Hospital, Vejle, Denmark (P.W.K.); Department of Orthopedic Surgery, Copenhagen University Hospital, Gentofte, Denmark (T.L.); and Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (H.K.).
• Anesthesiology. 2015 Apr 1;122(4):884-94.

BackgroundSufficient pain treatment remains a challenge after total knee arthroplasty (TKA), especially in high pain catastrophizing patients. Serotonergic signaling may be involved in pain processing, but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients.MethodsA total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects.ResultsPain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being -5 (-13 to 3), P = 0.20. Overall pain upon ambulation and at rest from days 2 to 6 was lower in the escitalopram versus placebo group, as was depression score at day 6 (all P ≤ 0.01 in analyses uncorrected for multiple tests). Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group. No other between-group differences were observed.ConclusionsEscitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients. Future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.

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