Multimodal Analgesia in Inguinal Hernia Repair Using a Cyclooxygenase-2-Specific Inhibitor: A Randomised Controlled Trial

Aim: To determine whether preoperative use of the highly cyclooxygenase-2-specific inhibitor rofecoxib combined with spinal anesthesia offers superior postoperative analgesia compared to spinal anesthesia alone. Methods: Single-centre, randomised, double-blinded, placebo-controlled trial, including 40 adult patients undergoing elective open inguinal hernia repair. Both the control (n=20) and treatment (n=20) groups received 10-12 mg of bupivacaine as local anesthesia and 25 μg of fentanyl as spinal anesthesia. Additionally, control patients received oral placebo, whereas the treatment group received 50 mg of oral rofecoxib 2 hours preoperatively. Results: Resting pain scores were significantly lower in the treatment group at 4, 16 and 24 hours postoperatively, as well as on discharge (p<0.05). Pain scores on active straight-leg raise were significantly lower at 16 hours, 24 hours, and on discharge (p<0.01, p<0.05 and p<0.05 respectively). Time to first analgesic dose was longer (p<0.001) and average analgesic doses were lower (p<0.001) in the treatment group. Finally, side-effect profiles were similar between groups. Conclusions: Preoperative rofecoxib administration in combination with spinal anesthesia is superior to spinal anesthesia alone in controlling pain after inguinal hernia repair. *Corresponding Author: Mostafa Somri, MD, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel 31048, Tel: +97248359230; E-mail: somri_m@yahoo.com