Fascia iliaca block for hip replacement – adjuvants and ethics. A reply
Notice bibliographique
Résumé
We thank Haque and Fregene for their interest in our study 1. As stipulated in our protocol 2, patients taking non-steroidal anti-inflammatory drugs (NSAID) pre-operatively continued to take these medications. No NSAIDs were commenced de novo in either treatment group during the study period. Whilst we agree that data relating to NSAID use could have provided additional information, we did not record this during the study period and unfortunately are unable to provide this information retrospectively. The non-significant difference in pre-operative paracetamol consumption referred to the single pre-medicant dose prescribed as part of the study protocol and not patients’ usual medications. Therefore, whilst we understand the suggestion about relative pain scores, this would not apply. As the study was randomised, we would not have expected significant differences between groups for this parameter, though agree that it could have provided further information about the baseline pain status of the study groups. We agree that any neuropraxia is a serious adverse event and reported this as such. The patient in this case made a full recovery. The nerve palsy was discussed at length with the surgical team who did not consider it likely to have resulted from the study intervention. The incidence of surgery-related femoral nerve palsy is reported as 0.1–2.4% with a mean of 0.8% 3. It is therefore difficult in practice to establish whether surgery or anaesthesia is causative. We accept the issue of sham blocks remains controversial. By virtue of using ultrasound to inject lateral and distant to the nerve, fascia iliaca block is considered a relatively low-risk procedure. As such, it is approved for use by non-medical practitioners in the UK 4. Our study underwent extensive peer review via grant applications and publication of the protocol, and sham fascia iliaca blocks have also recently been performed by other investigators 5. At the time of study design, we did not know that ultrasound-guided fascia iliaca block would be inferior to spinal morphine hence the performance of the trial. Our study was designed and underwent ethical review in October 2010. It has since been suggested that the use of any sham treatment be evaluated using the ‘SHAM tool’ 6. This aims to establish and minimise any risk of harm to the patient. This tool, first published in 2011, can aid investigators in the decision to use sham blocks in future study designs. No block is without risk, and the balance of risk and benefit is always a decision based on an individual patient guided by the best available evidence. Further work is still required to establish the optimal ultrasound-guided fascia iliaca block approach, and which hip surgery benefits most, if at all, from this technique in order to help clinicians when making these decisions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».