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.