39622
document
A prospective , randomized , comparative trial of a COX-2 selective nonsteroidal anti-inflammatory drug versus placebo in inguinal herniorrhaphy patients . OBJECTIVE The standard opioid treatment for postoperative pain can be associated with nausea , vomiting , and constipation . In addition , opioids often provide insufficient pain relief . The purpose of this study was to compare postoperative pain and functional outcomes in patients undergoing inguinal herniorrhaphy who receive a COX-2 selective nonsteroidal anti-inflammatory drug ( COX-2 ) or placebo preoperatively and for 4 days postoperatively . METHODS A prospective , randomized , blinded , placebo-controlled trial was conducted in adults undergoing elective , outpatient , unilateral inguinal herniorrhaphy . Patients received rofecoxib ( 50 mg , 1 h prior to incision ) or placebo . Doses were re-administered once daily on postoperative days 1-4 . Patients were also given hydrocodone bitartrate for use as needed in the postoperative period . Pain outcomes were assessed , including pain intensity ( 1-10 visual-analogue scale ) and the use of hydrocodone bitartrate . In addition , functional outcomes such as activity and return of bowel function were examined for 5 postoperative days . Incidence and severity of side effects were examined . Statistics are mean +/- standard deviation . RESULTS Fifty-five subjects completed the study . Twenty-six patients received rofecoxib and 29 patients received placebo . Patients who received COX-2 demonstrated improved bowel function as reflected by more bowel movements on postoperative day 2 and postoperative day 3 . COX-2-treated patients also reported better oral intake on these same days . In addition , COX-2-treated patients had less difficulty coughing on postoperative day 1 . Overall satisfaction with pain management was better in COX-2-treated patients ( very satisfied vs. satisfied ) . There were no statistically significant differences between groups in the amount of hydrocodone bitartrate consumption . There were no complications during the study period . CONCLUSIONS Administration of a COX-2 selective nonsteroidal anti-inflammatory drug prior to and following outpatient inguinal herniorrhaphy improves functional outcomes when compared with placebo and increases patient satisfaction . These results suggest that multimodal pain therapy with COX-2 inhibitors may have a role in outpatient inguinal hernia repair .
39623
Intervention_Pharmacological
COX-2 selective nonsteroidal anti-inflammatory drug
39624
Intervention_Control
placebo
39625
Intervention_Control
placebo-controlled
39626
Intervention_Pharmacological
rofecoxib
39627
Intervention_Control
placebo
39628
Intervention_Pharmacological
hydrocodone bitartrate
39629
Outcome_Pain
Pain
39630
Outcome_Pain
pain intensity
39631
Outcome_Physical
activity and return of bowel function
39632
Outcome_Adverse-effects
side effects
39633
Outcome_Physical
bowel function
39634
Outcome_Physical
oral intake
39635
Outcome_Physical
coughing
39636
Outcome_Pain
pain management
39637
Outcome_Adverse-effects
complications
39638
Participant_Condition
inguinal herniorrhaphy
39639
Participant_Condition
inguinal herniorrhaphy
39640
Participant_Age
adults
39641
Participant_Condition
unilateral inguinal herniorrhaphy
39642
Participant_Sample-size
Fifty-five
39643
Participant_Condition
outpatient inguinal hernia