Fascia iliaca block for hip replacement – adjuvants and ethics. A reply
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".