Re: "A Prospective Randomized Comparative Clinical Trial to Analyze Pain and Surgical Outcomes Between Frontal Nerve Blocks and Subconjunctival Anesthesia for Conjunctival Mullerectomy Resection".

Abstract

To the Editor: I read with great interest the article of Zatezalo et al. in a recent issue of the journal. The authors performed a randomized trial on 33 patients undergoing conjunctival Müller’s muscle resection and concluded that there was no statistically significant difference in pain scores or surgical outcomes in patients receiving frontal nerve block compared with those receiving subconjunctival injection. The authors should be congratulated for performing a well-designed study in an important topic (e.g., acute pain) in patients undergoing surgical procedures. The current emphasis on the need to reduce the use of opioids makes the topic very relevant in perioperative medicine. Although the study of Zatezalo et al. was well conducted, there are several questions regarding the study that need to be clarified to further confirm the validity of the results. First, it is unclear if the authors standardized the intraoperative and postoperative analgesic regimens as this can significantly affect the study results. Second, the authors did not detect a difference on pain scores, but it does not mean that they were able to prove noninferiority given the small sample size. Last, the authors evaluated multiple outcomes at different times, but they did not adjust their analysis to avoid Type I errors. I would welcome comments by the authors as this would provide further support of their findings of this important clinical trial.