Mostafa Somri1,2, Nasir Hawash3, Christopher Hadjittofi4, Marlain Ghantous-Toukan5, Riad Tome3, Marina Yodashkin3, Ibrahim Matter6,7. 1. Department of Anesthesia, Bnai Zion Medical Center, 47 Golomb St., 31048, Haifa, Israel. somri_m@yahoo.com. 2. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel. somri_m@yahoo.com. 3. Department of Anesthesia, Bnai Zion Medical Center, 47 Golomb St., 31048, Haifa, Israel. 4. Department of General Surgery, Epsom and St. Helier University Hospitals, Wrythe Lane, Carshalton, SM5 1AA, UK. 5. Department of Gynecology, Bnai Zion Medical Center, 47 Golomb St., 31048, Haifa, Israel. 6. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel. 7. Department of General Surgery, Bnai Zion Medical Center, 47 Golomb St., 31048, Haifa, Israel.
Abstract
BACKGROUND:Inguinal hernia repair is a common procedure, and can be performed under spinal anesthesia. Although adequate analgesia is crucial to postoperative recovery, the optimal protective analgesic regimen remains to be established. PURPOSE: To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair. METHODS:Sixty adult patients undergoing open inguinal hernia repair participated in a single-center, randomized, double-blinded, placebo-controlled trial in a general academic medical center. The intervention group (n = 30) received 120 mg of oral etoricoxib 1 h preoperatively, and 10-12 mg bupivacaine with 25 μg fentanyl as spinal anesthesia. The control group (n = 30) received oral placebo 1 h preoperatively, and spinal anesthesia as above. Postoperative Visual Analog Scale pain scores at rest and on active straight leg raise were recorded and analyzed. RESULTS:Resting pain scores were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.00 vs. 4.35; 1.57 vs. 4.00; 1.24 vs. 3.76, respectively; p < 0.05). Pain scores on active straight leg raise were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.85 vs. 5.59, p < 0.01; 2.84 vs. 4.90, p < 0.05; 3.55 vs. 5.32, p < 0.05, respectively). CONCLUSION: The addition of etoricoxib to spinal anesthesia as a multimodal protective regimen can improve pain controlafter inguinal hernia repair. The optimal dose and applicability to other operations remains to be established.
RCT Entities:
BACKGROUND:Inguinal hernia repair is a common procedure, and can be performed under spinal anesthesia. Although adequate analgesia is crucial to postoperative recovery, the optimal protective analgesic regimen remains to be established. PURPOSE: To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair. METHODS: Sixty adult patients undergoing open inguinal hernia repair participated in a single-center, randomized, double-blinded, placebo-controlled trial in a general academic medical center. The intervention group (n = 30) received 120 mg of oral etoricoxib 1 h preoperatively, and 10-12 mg bupivacaine with 25 μg fentanyl as spinal anesthesia. The control group (n = 30) received oral placebo 1 h preoperatively, and spinal anesthesia as above. Postoperative Visual Analog Scale pain scores at rest and on active straight leg raise were recorded and analyzed. RESULTS: Resting pain scores were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.00 vs. 4.35; 1.57 vs. 4.00; 1.24 vs. 3.76, respectively; p < 0.05). Pain scores on active straight leg raise were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.85 vs. 5.59, p < 0.01; 2.84 vs. 4.90, p < 0.05; 3.55 vs. 5.32, p < 0.05, respectively). CONCLUSION: The addition of etoricoxib to spinal anesthesia as a multimodal protective regimen can improve pain control after inguinal hernia repair. The optimal dose and applicability to other operations remains to be established.