Dear Editor,
We read with great interest the article by Kir and Kir [1] in a recent issue of Medical Principles and Practice. The authors performed a prospective randomized study on 60 patients undergoing hallux valgus surgery and concluded that ankle block added to general anesthesia may improve early and mid-term postoperative functional outcomes and postoperative pain management in patients who undergo hallux valgus surgery. The authors should be congratulated for performing a study on an important topic in patients undergoing orthopedic surgery [2]. Moreover, the current emphasis on the need to use nonopioid strategies to improve postoperative pain makes the subject very relevant to perioperative medicine [3, 4].
Although the study by Kir and Kir [1] was well conducted, there are questions that need to be clarified by the authors to support the validity of the results. First, the analgesic efficacy of ankle block is well established in control groups with no analgesic interventions. Second, the analgesic performance of ankle blocks on more important patient-centered outcomes would have been beneficial to the literature and would have been more informative than just pain scores alone. Last, the identity of the person who collected immediate postoperative data was not mentioned. The collection of pain scores by clinical nurses has been shown to be problematic in analgesic studies [5].
Disclosure Statement
The authors declare no conflicts of interest. No financial support was received for this paper.
References
- 1.Kir M, Kir G. Ankle nerve block adjuvant to general anesthesia reduces post-surgical pain and improves functional outcomes in hallux valgus surgery. Med Princ Pract. 2018 doi: 10.1159/000488321. DOI: 10.1159/000488321, Epub ahead of printz. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lu J, Chen G, Zhou H, et al. Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: a randomized double blinded controlled trial. J Clin Anesth. 2017;41:30–34. doi: 10.1016/j.jclinane.2017.06.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Zhang Z, Xu H, Zhang Y, et al. Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: a meta-analysis of randomized controlled trials. J Clin Anesth. 2017;43:84–89. doi: 10.1016/j.jclinane.2017.08.030. [DOI] [PubMed] [Google Scholar]
- 4.Li XD, Han C, Yu WL. Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials. J Clin Anesth. 2017;41:76–83. doi: 10.1016/j.jclinane.2017.07.002. [DOI] [PubMed] [Google Scholar]
- 5.McCarthy RJ, De Oliveira., GS The trouble with using provider assessments for rating clinical performance: it's a matter of bias. Anesth Analg. 2015;120:714–716. doi: 10.1213/ANE.0000000000000593. [DOI] [PubMed] [Google Scholar]