Systematic ReviewResearchMedication Safety

Duloxetine offered small pain reductions after joint replacement but increased drowsiness

Journal of orthopaedic surgery and research (PubMed)Sep 2, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A meta-analysis found small pain-score improvements with perioperative duloxetine after hip or knee replacement, alongside increased drowsiness.

What NurseJet pulled from the source

Thirteen randomized trials included 1,176 patients. At 24 hours, pain reductions averaged about five points on a 100-point scale; the authors characterized analgesic effects as statistically significant but below their clinical threshold.

Why this matters for nurses

For nurses, modest average analgesic benefit needs to be considered alongside observed sedation.

Bedside takeaway

Reassess pain and drowsiness when duloxetine is part of prescribed postoperative analgesia.

How This Applies in Practice

Use this when: Caring for a joint-replacement patient receiving duloxetine.

On your shift

Report troublesome drowsiness and inadequate pain relief to the treating team.

Keep in mind: Follow facility policy and provider orders; the review does not establish a universal regimen.

Key takeaways

Drowsiness/somnolence was more frequent with duloxetine (risk ratio 1.88).
Opioid-sparing estimates at 48-72 hours had extreme heterogeneity.

Practice implications

When duloxetine is prescribed, assess pain during rest and movement and document drowsiness rather than assuming less opioid use means better recovery.

Limitations & cautions

Abstract-only summary. Substantial heterogeneity limits confidence; some apparent longer-term and adverse-effect benefits lost statistical significance after one high-risk trial was removed.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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Journal of orthopaedic surgery and research (PubMed)

Journal of orthopaedic surgery and research (PubMed). Duloxetine for postoperative pain management in total hip and knee arthroplasty: a systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42687183/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

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Research ArticleResearchQuality ImprovementAI summary · original source linked below

Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of the American Medical Directors Association (PubMed)Sep 5, 2026Research Article

A prospective Dutch nursing-home cohort found clinically important differences in illness burden across respiratory viruses, with influenza and human metapneumovirus standing out.

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Among 3,195 residents at 15 nursing homes, 526 suspected acute respiratory-infection episodes were recorded and a virus was identified in 291. Influenza A was associated with delayed recovery, oxygen use, and threefold secondary-bacterial-pneumonia risk; hMPV was linked to fourfold more time in bed.

Key takeaways

SARS-CoV-2, influenza A, rhinovirus or enterovirus, and RSV were the most frequently identified viruses.
hMPV and RSV tended to have higher odds of moderate or severe disease.
Virus-specific patterns were associations from a cohort, not randomized comparisons.

Why this matters on shift

Frailty can amplify respiratory-infection consequences, and the causative virus may help anticipate recovery, oxygen, mobility, and secondary-infection needs.

Bedside takeaway

Trend oxygen needs, mobility, recovery, and secondary-pneumonia signs during nursing-home respiratory infections.

Nursing implications

During outbreaks or suspected infection, trend oxygen needs, mobility and time in bed, recovery, and signs of bacterial pneumonia according to facility protocols.

Limitations & cautions

Abstract-only summary. Data came from 15 Dutch nursing homes, the overall suspected-infection risk estimate was imprecise, and virus-outcome comparisons may be affected by confounding and small subgroup counts.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of the American Medical Directors Association (PubMed). Clinical Impact of Acute Respiratory Virus Infections in Nursing Home Residents.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

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One in four laboratory-defined AKI cases went undocumented on medicine wards

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