Protective multimodal analgesia with etoricoxib and spinal anesthesia in inguinal hernia repair: a randomized controlled trial.

Abstract

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. To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair. 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 120mg of oral etoricoxib 1h preoperatively, and 10-12mg bupivacaine with 25μg fentanyl as spinal anesthesia. The control group (n=30) received oral placebo 1h preoperatively, and spinal anesthesia as above. Postoperative Visual Analog Scale pain scores at rest and on active straight leg raise were recorded and analyzed. Resting pain scores were significantly lower in the intervention than the control group at 16h, 24h, 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 16h, 24h, 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). 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.