DOI: 10.1097/01.sa.0000220714.47072.9f
,
Issn Print: 0039-6206
Publication Date: 2006/06/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Dorothy J. Pavlin, Edward G. Pavlin, Karen D. Horvath, Laurie B. Amundsen, David R. Flum, and Kristine Roesen
(Anesth Analg, 101:83-89, 2005)
Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA.
Postoperative pain can be severe for patients undergoing open inguinal hernia repair. When general anesthesia is elected, pain control at the study institution has often consisted of surgeon-administered local anesthetic at the wound site, IV opioids in the recovery unit, and an oral opioid/acetaminophen combination after discharge. The efficacy of this standard regimen was compared with that of a local anesthetic field block before surgery, alone or in combination with rofecoxib.
Seventy-five adult patients were randomly assigned to a placebo control group (CONT), a group given a bupivacaine field block in the inguinal region before surgery and perioperative placebo (PL), or a group that received a preoperative field block plus rofecoxib, 50 mg preoperatively and for 5 days postoperatively (PLR). All patients were given an infiltration of bupivacaine in the wound at closure and IV fentanyl and acetaminophen/oxycodone postoperatively. The 3 study groups were compared for discharge time, pain scores, analgesic requirements, and satisfaction with pain control and the overall recovery process.
The 3 groups were similar in mean age, weight, and the duration of both surgery and anesthesia. Compared with the CONT group, patients in groups PL and PLR received less fentanyl intraoperatively (39% and 31% less, respectively). Pain scores were lower in both PL and PLR groups than in the CONT group in the first 30 minutes of recovery. At 24 hours after discharge, but not at 48 hours or 7 days, maximum pain scores were lower and opioid use was reduced in the PLR group compared with the CONT group. The PLR group had higher satisfaction scores at 48 hours than both PL or CONT groups. Postoperative voiding difficulties did not differ importantly among groups.
Patients who received rofecoxib plus local anesthetic field block before inguinal hernia repair experienced better pain control with a lower opioid dose and improved satisfaction scores in the first 24 hours after surgery when compared with similar patients assigned to other analgesic regimens.
