Perioperative Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitor Use in Lower Extremity Total Joint Arthroplasty

Postoperative pain control following lower extremity total joint arthroplasty (TJA) poses a challenge for many patients, especially those with comorbid conditions such as chronic pain, anxiety, and depression. Multimodal pain control may improve functional outcomes and decrease opioid consumption for these patients. Perioperative use of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) surrounding lower extremity TJA have been increasingly studied for their potential role in improving postoperative outcomes. There is a growing body of literature supporting the use of SNRIs such as duloxetine as a part of multimodal postoperative pain control following lower extremity TJA, especially following total knee arthroplasty. Although SSRIs have not been shown to improve postoperative pain scores in patients with comorbid anxiety or depression, they may demonstrate improved functional outcomes compared with similar patients who were not taking SSRIs. Additional research on both SSRI and SNRI use surrounding lower extremity joint replacement is needed to better understand their potential role in managing postoperative pain and functional outcomes. Nonpharmacological solutions such as preprocedural anxiety/depression screening, mental health referrals, and preoperative education may also improve outcomes; however, more high-quality studies on the topic are needed.