Reporting of time to rescue analgesia
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.108 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.015 | 0.017 |
| Insufficient payload (model declined to judge) | 0.005 | 0.004 |
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 source (direct Gemma or distilled Codex), 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".