Somri Mostafa, Hawash Nasir, Hadjittofi Christopher, Ghantous-Toukan Marlain, Tome Riad, Yodashkin Marina, Matter Ibrahim
Department of Anesthesia, Bnai Zion Medical Center, 47 Golomb St., 31048, Haifa, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel.
J Anesth. 2017 Oct;31(5):645-650. doi: 10.1007/s00540-017-2368-5. Epub 2017 Apr 28.
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 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.
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).
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.
腹股沟疝修补术是一种常见手术，可在脊髓麻醉下进行。尽管充分镇痛对术后恢复至关重要，但最佳的预防性镇痛方案仍有待确定。
探讨术前使用依托考昔在开放性腹股沟疝修补术后的多模式预防性镇痛方案中对疼痛控制的影响。
60例接受开放性腹股沟疝修补术的成年患者参与了一家综合学术医学中心的单中心、随机、双盲、安慰剂对照试验。干预组（n = 30）在术前1小时口服120毫克依托考昔，并使用10 - 12毫克布比卡因加25微克芬太尼进行脊髓麻醉。对照组（n = 30）在术前1小时口服安慰剂，并采用上述脊髓麻醉方法。记录并分析术后静息和主动直腿抬高时的视觉模拟评分疼痛分数。
干预组在术后16小时、24小时及出院时的静息疼痛分数显著低于对照组（分别为3.00对4.35；1.57对4.00；1.24对3.76；p < 0.05）。干预组在术后16小时、24小时及出院时主动直腿抬高时的疼痛分数显著低于对照组（分别为3.85对5.59，p < 0.01；2.84对4.90，p < 0.05；3.55对5.32，p < 0.05）。
在脊髓麻醉中添加依托考昔作为多模式预防性方案可改善腹股沟疝修补术后的疼痛控制。最佳剂量及对其他手术的适用性仍有待确定。
