Ma Hong, Tang Jun, White Paul F, Zaentz Alan, Wender Ronald H, Sloninsky Alexander, Naruse Robert, Kariger Robert, Quon Raymond, Wood Dennis, Carroll Brendan J
Department of *Anesthesiology & Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; Departments of †Anesthesia and ‡Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Anesth Analg. 2004 Apr;98(4):970-975. doi: 10.1213/01.ANE.0000111110.94186.55.
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.
Rofecoxib (50 mg per os), given before and after surgery, was effective in improving postoperative pain management, as well as the speed and quality of recovery after outpatient inguinal herniorrhaphy. However, it failed to accelerate the postdischarge resumption of normal activities of daily living.
非阿片类镇痛药作为门诊疼痛管理多模式方案的一部分，越来越受欢迎。我们设计了这项随机、双盲、安慰剂对照研究，以评估围手术期给予环氧化酶-2抑制剂罗非昔布对腹股沟疝修补术后患者预后的影响。60名同意参与的择期疝修补手术门诊患者被随机分配到两个治疗组之一：对照组（维生素C，500毫克）或罗非昔布组（罗非昔布，50毫克）。研究药物的第一剂口服给药在进入手术室前30 - 40分钟进行，第二剂相同药物在术后第一天早晨给予。在从恢复室出院前，每隔1 - 10分钟记录恢复时间、术后疼痛评分、使用“解救”镇痛药的需求以及副作用。在术后36小时、7天和14天进行随访评估，以评估出院后疼痛、镇痛药需求、恢复正常活动情况以及患者对术后疼痛管理的满意度。罗非昔布显著缩短了早期恢复时间，使术后更早出院回家（88 ± 30分钟对126 ± 44分钟，P < 0.05）。与对照组相比，罗非昔布组患者恢复质量评分的中位数[范围]也显著更高（18 [14 - 18]对16 [13 - 18]，P < 0.05）。在出院前阶段，对照组需要解救性镇痛药的患者比例显著更高（67%对罗非昔布组的37%，P < 0.05）。在36小时随访评估时，接受罗非昔布治疗的患者报告口服镇痛药需求显著减少（0 [0 - 20]片对9 [1 - 33]片，P < 0.05），最大疼痛评分更低，从而提高了患者对术后疼痛管理的满意度（3 [1 - 4]对2 [0 - 3]，P < 0.05）。然而，恢复日常生活活动所需时间没有差异。总之，围手术期口服50毫克罗非昔布显著降低了术后疼痛以及对镇痛药解救的需求，使门诊疝修补术后恢复更快且恢复质量得到改善。然而，围手术期使用罗非昔布未能改善出院后恢复终点。
手术前后给予罗非昔布（口服50毫克）在改善术后疼痛管理以及门诊腹股沟疝修补术后的恢复速度和质量方面是有效的。然而，它未能加速出院后正常日常生活活动的恢复。
