CORRESPONDENCE Disclosure Letter: Bupivacaine Field Block With Clonidine The authors have no personal, financial, or institutional interest in any of the for Postoperative Pain Control in Posterior drugs, materials, or devices described in this article. Spine Approaches: A Randomized Double-Blind Trial Mark C. Kendall, MD To the Editor: LucasJ.Castro-Alves,MD We read with great interest the article of Abdel Hay et al Department of Anesthesiology in a recent issue of Neurosurgery. The authors performed a Rhode Island Hospital randomized trial on 225 patients undergoing lumbar and cervical Warren Alpert Medical School of Brown University spine surgery and concluded that the addition of clonidine to Providence, Rhode Island local preincisional field block with bupivacaine resulted in better and prolonged postoperative analgesia in posterior lumbar spine REFERENCES surgeries, an effect that was more pronounced in patients with 1. Abdel Hay J, Kobaiter-Maarrawi S, Tabet P, et al. Bupivacaine field block with no preoperative spinal pain. The authors should be congratulated clonidine for postoperative pain control in posterior spine approaches: a randomized for performing a well-designed trial in an important topic (eg, double-blind trial. Neurosurgery. 2017. doi: 10.1093/neuros/nyx313 [published 2-3 acute pain) in patients undergoing spine surgery. The current online ahead of print]. 2. Duttchen KM, Lo A, Walker A, et al. Intraoperative ketorolac dose of emphasis on the need to use local anesthetics to improve patient 15 mg versus the standard 30 mg on early postoperative pain after spine recovery after surgery makes the topic very relevant in perioper- surgery: a randomized, blinded, non-inferiority trial. J Clin Anesth. 2017 Sep;41: 4-5 ative medicine. 11-15. 3. Yavin D, Casha S, Wiebe S, et al. Lumbar fusion for degenerative disease: a Although the study of Abdel Hay et al was well conducted, systematic review and meta-analysis. Neurosurgery. 2017;80(5):701-715. there are some concerns regarding the study that need to be 4. López M, Calvo M, Sancho A, Brogly N, Guasch E, Gilsanz clarified. First, it is not clear if the authors standardized the F. Effective volumes of 1.5% mepivacaine with different sodium concen- intraoperative and postoperative analgesic consumption as this tration for ultrasound guided popliteal block. J Clin Anesth. 2017 Feb;37: 139-144. can significantly alter the outcomes. Secondly, the authors did 5. El Sherif FA, Mohamed SA, Kamal SM. The effect of morphine added to bupiva- not adjust their analysis to surgical duration as this variable has caine in ultrasound guided transversus abdominis plane (TAP) block for postoper- been shown to be associated with poor outcomes following spine ative analgesia following lower abdominal cancer surgery, a randomized controlled surgery. Lastly, it remains to be determined if the analgesic study. J Clin Anesth. 2017;39:4-9. 6. Kim BD, Hsu WK, De Oliveira GS, Jr, Saha S, Kim JY. Operative duration difference reported by the authors is clinically significant since as an independent risk factor for postoperative complications in single-level lumbar they did not include any patient-centered instrument as one of fusion. Spine. 2014 Jun;39(6):510-520. the evaluated outcomes. We would welcome some comments by the authors as this would help to further substantiate the findings of this important 10.1093/neuros/nyy162 clinical trial. NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/neurosurgery/advance-article-abstract/doi/10.1093/neuros/nyy162/4992745 by Ed 'DeepDyve' Gillespie user on 07 June 2018
Neurosurgery – Oxford University Press
Published: May 4, 2018
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