Reply to ‘assessing postoperative benefits of regional blocks: an issue should be noticed’

Abstract

To the editor We are grateful to Xue et al for their interest in our recent clinical trial concerning the suprainguinal fascia iliaca compartment block (SFICB) and its role in the management of postoperative analgesia after posterolateralapproached total hip arthroplasties (PLTHA). 2 In our trial, we wanted to report how this peripheral nerve block (PNB) technique can be useful in reducing postoperative pain by improving functional performance after PLTHA. We thank Xue et al for giving us the opportunity to clarify and emphasise some methodological aspects of our study and we are pleased to respond to their accurate observation. First, in our trial, SFICB was used in the context of multimodal analgesia, including Cox2selective nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen and dexamethasone. The details of this scheme are given in Appendix 1 of our publication. As recommended by the recent PROcedure SPEcific postoperative pain managemenT (PROSPECT) guidelines, not only does the evidence support the use of these molecules but recommends that trials inherent to postoperative analgesia research include multimodal schemes consistent with current clinical practice, with at least acetaminophen/NSAID/dexamethasone administration. In addition to preoperative NSAID and intraoperative acetaminophen and dexamethasone, all patients included in the trial received 60 mg etoricoxib once daily and acetaminophen 1 g every 6 hours postoperatively, as a complement to the PatientControlled Analgesia device. We acknowledge that his may have not appeared clearly enough in the Methods section of our manuscript. We believe that further studies on postoperative analgesia and the impact of different PNB techniques on functional recovery after PLTHA are needed. In line with the comment of Xue et al, we do agree that further research should obviously include the new PNBs only in the context of a basic multimodal analgesia regimen consistent with the evidence reported in the most recent guidelines. 4 Michele Carella , Florian Beck , Nicolas Piette, JeanPierre Lecoq, Vincent L Bonhomme 1,3 Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGAI3 Thematic Unit, GIGAResearch, Liege University, Liege, Belgium Anesthesia and Perioperative Neuroscience Laboratory, GIGAConsciousness Thematic Unit, GIGAResearch, Liege University, Liege, Belgium