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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
Address correspondence and reprint requests to Dr. Paul F. White, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390–9068. Address e-mail to paul. white{at}utsouthwestern.edu
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.
IMPLICATIONS: 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.
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  P. F. White Pain management after ambulatory surgery - Where is the disconnect?/La prise en charge de la douleur apres une chirurgie ambulatoire : ou est-ce que ca coince ? Can J Anesth, April 1, 2008; 55(4): 201 - 207. [Full Text] [PDF]
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 T. Sun, O. Sacan, P. F. White, J. Coleman, R. J. Rohrich, and J. M. Kenkel Perioperative Versus Postoperative Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures Anesth. Analg., March 1, 2008; 106(3): 950 - 958. [Abstract] [Full Text] [PDF]
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P. F. White, H. Kehlet, J. M. Neal, T. Schricker, D. B. Carr, F. Carli, and the Fast-Track Surgery Study Group The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care Anesth. Analg., June 1, 2007; 104(6): 1380 - 1396. [Abstract] [Full Text] [PDF]
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P. F. White, O. Sacan, B. Tufanogullari, M. Eng, N. Nuangchamnong, and B. Ogunnaike Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery: [Effet de l'administration postoperatoire a court terme de celecoxib sur l'evolution des patients apres une chirurgie par laparoscopie sans hospitalisation] Can J Anesth, May 1, 2007; 54(5): 342 - 348. [Abstract] [Full Text] [PDF]
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A. Hadzic, B. Kerimoglu, D. Loreio, P. E. Karaca, R. E. Claudio, M. Yufa, R. Wedderburn, A. C. Santos, and D. M. Thys Paravertebral Blocks Provide Superior Same-Day Recovery over General Anesthesia for Patients Undergoing Inguinal Hernia Repair. Anesth. Analg., April 1, 2006; 102(4): 1076 - 1081. [Abstract] [Full Text] [PDF]
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A. Turan, P. F. White, B. Karamanlioglu, D. Memis, M. Tasdogan, Z. Pamukcu, and E. Yavuz Gabapentin: An Alternative to the Cyclooxygenase-2 Inhibitors for Perioperative Pain Management Anesth. Analg., January 1, 2006; 102(1): 175 - 181. [Abstract] [Full Text] [PDF]
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P. F. White The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22. [Abstract] [Full Text] [PDF]
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D. J. Pavlin, E. G. Pavlin, K. D. Horvath, L. B. Amundsen, D. R. Flum, and K. Roesen Perioperative Rofecoxib Plus Local Anesthetic Field Block Diminishes Pain and Recovery Time After Outpatient Inguinal Hernia Repair Anesth. Analg., July 1, 2005; 101(1): 83 - 89. [Abstract] [Full Text] [PDF]
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P. F. White Update on ambulatory anesthesia Can J Anesth, June 1, 2005; 52(suppl_1): R10 - R10. [Full Text] [PDF]
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P. F. White Changing Role of COX-2 Inhibitors in the Perioperative Period: Is Parecoxib Really the Answer? Anesth. Analg., May 1, 2005; 100(5): 1306 - 1308. [Full Text] [PDF]
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M. Beaussier, H. Weickmans, C. Paugam, S. Lavazais, J. P. Baechle, P. Goater, A. Buffin, J. F. Loriferne, J. F. Perier, J. P. Didelot, et al. A Randomized, Double-Blind Comparison Between Parecoxib Sodium and Propacetamol for Parenteral Postoperative Analgesia After Inguinal Hernia Repair in Adult Patients Anesth. Analg., May 1, 2005; 100(5): 1309 - 1315. [Abstract] [Full Text] [PDF]
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B. L. Friedberg and P. F. White Paradoxical Increase in Pain Requirements with Midazolam Premedication * Response Anesth. Analg., October 1, 2004; 99(4): 1268 - 1269. [Full Text] [PDF]
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