Non-opioid analgesics have become increasingly popular as part of a multimodal regimen for
pain management in the ambulatory setting. We designed this randomized, double-blind, placebo-controlled study to evaluate the effect of perioperative administration of the
cyclooxygenase-2 inhibitor rofecoxib on patient outcome after inguinal
herniorrhaphy procedures. Sixty consenting outpatients undergoing elective
hernia repair surgery were randomly assigned to one of two treatment groups: control (
vitamin C, 500 mg) or
rofecoxib (
rofecoxib, 50 mg). The first oral dose of the study medication was administered 30-40 min before entering the operating room, and a second dose of the same medication was given on the morning of the first postoperative day. Recovery times,
postoperative pain scores, the need for "rescue"
analgesics, and side effects were recorded at 1- to 10-min intervals before discharge from the recovery room. Follow-up evaluations were performed at 36
h, 7 days, and 14 days after surgery to assess postdischarge
pain,
analgesic requirements, resumption of normal activities, as well as patient satisfaction with their
postoperative pain management.
Rofecoxib significantly decreased the early recovery times, leading to an earlier discharge home after surgery (88 +/- 30 vs 126 +/- 44 min, P < 0.05). When compared with the control group, the patients' median [range] quality of recovery score was also significantly higher in the
rofecoxib group (18 [14-18] vs 16 [13-18], P < 0.05). In the predischarge period, a significantly larger percentage of patients required rescue
pain medications in the control group (67% vs 37% in the
rofecoxib group, P < 0.05). At the 36-h follow-up assessment,
rofecoxib-treated patients reported significantly reduced oral
analgesic requirements (0 [0-20] vs 9 [1-33] pills, P < 0.05) and lower maximal
pain scores, resulting in improved patient satisfaction with their
postoperative pain management (3 [1-4] vs 2 [0-3], P < 0.05). However, there were no differences in the times required to resume their
activities of daily living. In conclusion, perioperative
rofecoxib, 50 mg per os, significantly decreased
postoperative pain and the need for
analgesic rescue medication, leading to a faster and improved quality of recovery after outpatient
hernia surgery. However, perioperative use of
rofecoxib failed to improve recovery end points in the postdischarge period.
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