Journal of Anesthesia and Surgery J Anesth Surg | volume 2: issue 2 Introduction Open inguinal hernia repair (IHR) is one of the commonest surgical procedures and one which may provoke pain of variable intensity and duration. Acute untreated pain can occasionally persist as a chronic problem due to increased prostaglandin synthesis [1,2] . Maximal prostaglandin concentration is reached at 3-4 hours after injury and this infammatory process may last for 12 to 48 hours, which correlates with the peak intensity of postoperative pain [3] . In many cases, IHR is performed in an ambulatory fashion, therefore efective pain management allows early discharge and a comfortable post-operative period for the patient at home. Copy rights: ©2016 Somri, M. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License. 61 Research Article 1 Department of Anesthesia, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel 2 The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. Haifa, Israel 3 HPB & Liver Transplant Surgery Department, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, United Kingdom 4 Department of Urology, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel 5 Department of Cardiothoracic Surgery, Carmel Medical Center, 7 Michal St. Haifa, Israel 6 Department of General Surgery, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel 7 Department of Gastrointestinal Medicine, Barts Health NHS Trust, W Smithfeld, London, EC1A 7BE, United Kingdom 8 Department of General Surgery, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel Abstract Aim: To determine whether preoperative use of the highly cyclooxygenase-2-spe- cifc inhibitor rofecoxib combined with spinal anesthesia ofers superior postopera- tive analgesia compared to spinal anesthesia alone. Methods: Single-centre, randomised, double-blinded, placebo-controlled trial, in- cluding 40 adult patients undergoing elective open inguinal hernia repair. Both the control (n=20) and treatment (n=20) groups received 10-12 mg of bupivacaine as local anesthesia and 25 μg of fentanyl as spinal anesthesia. Additionally, control patients received oral placebo, whereas the treatment group received 50 mg of oral rofecoxib 2 hours preoperatively. Results: Resting pain scores were signifcantly lower in the treatment group at 4, 16 and 24 hours postoperatively, as well as on discharge (p<0.05). Pain scores on active straight-leg raise were signifcantly lower at 16 hours, 24 hours, and on discharge (p<0.01, p<0.05 and p<0.05 respectively). Time to frst analgesic dose was longer (p<0.001) and average analgesic doses were lower (p<0.001) in the treatment group. Finally, side-efect profles were similar between groups. Conclusions: Preoperative rofecoxib administration in combination with spinal anesthesia is superior to spinal anesthesia alone in controlling pain after inguinal hernia repair. * Corresponding Author: Mostafa Somri, MD, Bnai Zion Medical Center, 47 Golomb St. Haifa, Israel 31048, Tel: +97248359230; E-mail: somri_m@yahoo.com Keywords: Rofecoxib; Spinal; Anesthesia; Multimodal; Analgesia; Hernia Citation: Somri, M., et al. Multimodal Analgesia in Inguinal Hernia Repair Using a Cyclooxygenase-2-Specifc Inhibitor: A randomised controlled trial. (2016) J Anesth Surg 2(2): 61-65. Multimodal Analgesia in Inguinal Hernia Repair Using a Cyclooxy- genase-2-Specifc Inhibitor: A randomised controlled trial Mostafa Somri 1,2* , Christopher Hadjittof 3 , Sarel Halachmi 2,4 , Hoash Naser 1 , Majed Kabaha 2,5 , Dan Shteinberg 2,6 , Constantinos A Parisinos 7 , Ibrahim Matter 2,8 Received date: May 17, 2015 Accepted date: November 09, 2015 Published date: November 13, 2015 DOI: 10.15436/2377-1364.15.021 Somri, M., et al.