Reporting of time to rescue analgesia
Notice bibliographique
Résumé
Editor, We read with great interest the article published in the European Journal of Anaesthesiology to evaluate the ability of the pectoral nerve block to decrease postoperative pain and improve postoperative quality of recovery (QoR) in patients undergoing breast cancer surgery.1 The authors reported that the pectoral nerve block improved postoperative pain but not the postoperative QoR-40 score.1 There are a few concerns regarding the methodology of the study and the reporting of the results. Surgical procedures with variable incision size and extent of tissue trauma were studied. No definition of break-through pain was provided. Rescue analgesia was used in form of diclofenac suppositories as a first choice and intramuscular pethidine as a second-line rescue treatment. Peak action of diclofenac suppositories is usually reached within 1 h. Thus, the drug is not expected to act fast. What was the time to the first rescue analgesic? How long did the authors wait before the second rescue was administered? It is possible that patients in pectoral nerve block group had break-through pain during the first postoperative hour and received a rescue bolus, and thereafter, consecutive pain scores were lower in pectoral nerve block group. Reporting of time to first rescue would have limited these speculations. In any randomised double blind placebo controlled trial, providing immediate access to incremental rescue analgesia reduces the odds that patients, especially those randomised to placebo, would experience unrelieved severe pain.2 Further, requirement of rescue analgesic was the same in both groups, indicating that the pectoral nerve block did not decrease the requirement for rescue analgesia. Furthermore, when the ultrashort acting opioid remifentanil is given intra-operatively, it produces a significant negative postoperative opioid sparing effect, that is increased opioid use in patients receiving the study drug compared with placebo, consistent with previous animal and adult human studies showing remifentanil's potential to induce hyperalgesia and acute tolerance.3 To conclude, intra-operative requirements of remifentanil and postoperative need of rescue analgesia were similar in both groups indicating the inability of the pectoral nerve block to anaesthetise the median part of chest wall. It is possible that in addition to no effect on QoR, the pectoral nerve block did not decrease postoperative pain scores, and lower visual analogue score scores in the pectoral nerve group resulted from earlier administration of rescue analgesics in this group. Acknowledgements relating to this article Assistance with the letter: none. Financial support and sponsorship: none. Conflicts of interest: none. Comment from the Editor: Dr Kamiya et al. did not respond to our invitation to submit a reply to this letter.
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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 | 0,005 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 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 | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
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 ».