Electronic Letters to:

Upper Limb: J. Kean, C. A. Wigderowitz, and D. M. Coventry Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder: A DOUBLE-BLIND, RANDOMISED CONTROLLED TRIAL J Bone Joint Surg Br 2006; 88-B: 1173-1177 [Abstract] [Full text] [PDF]

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Continuous interscalene infusion

Rebecca Owens, George Samsoon, Mark Curtis   (20 October 2006)

Continuous interscalene infusion and single injection using levobupivicaine for post-op analgesia

Wiqqas Jamil, Puneet Monga, Rohit Jain   (3 October 2006)

Continuous interscalene infusion 20 October 2006
Rebecca Owens, SpR Orthopaedics , George Samsoon, Mark Curtis Send letter to journal: Re: Continuous interscalene infusion beckywowens{at}hotmail.com Rebecca Owens, et al.	Sir, We read this article with interest and have several questions for the authors. This trial included a heterogenous group of ‘major’ shoulder surgical procedures. Our experience suggests that analgesic requirements vary greatly between patients and types of operation, and that patients having had an open cuff repair constitute a subgroup with severe post-operative pain, certainly in comparison with a simple decompression. We would be interested to hear if the authors have a similar experience and if the operative procedure in each arm of the trial was matched to address this issue. We cannot understand why a patient was excluded following dislodgement of the catheter (surely not a rare clinical complication), as most trials are analysed on an ‘intention to treat’ basis when individuals switch or stop taking the treatment to prevent bias.1 How do the authors justify excluding a patient following catheter dislodgement? Would this have affected the statistical analysis given the small numbers in each subgroup? G. Samsoon FRCA, M.J. Curtis FRCS, R. Owens MRCS, The Shoulder Unit, Kingston General Hospital, Kingston Upon Thames, UK. 1. Petrie A. Review Article. Statistics in orthopaedic papers. J Bone Joint Surg [Br] 2006;88-B:1121-36.
Continuous interscalene infusion and single injection using levobupivicaine for post-op analgesia 3 October 2006
Wiqqas Jamil, Clinical Fellow - Orthopaedics Wythenshawe Hospital, Puneet Monga, Rohit Jain Send letter to journal: Re: Continuous interscalene infusion and single injection using levobupivicaine for post-op analgesia drwjamil{at}doctors.net.uk Wiqqas Jamil, et al.	Sir, We read this paper with great interest. It has been suggested that continuous interscalene infusion of levobupivicaine is an effective method of post-operative analgesia following surgery. We would like to congratulate the authors on conducting this well-designed study. However, we do not necessarily agree with all of their conclusions. The power has been calculated for the primary outcome measure of visual analogue scores at 24 hours post-operatively. However, Table 1 demonstrates that a statistically significant difference between the two groups is only apparent at 12 hours. Also, as the study was powered for the VAS score, the findings of reduced morphine requirement may not necessarily have any statistical significance. Do we have sufficient evidence to infer that continuous infusion offers considerably better pain relief than a single bolus dose, as the study had originally set out to determine? The patients within both groups had undergone different procedures. It is not unreasonable to suggest that the pain burden associated with a hemiarthroplasty would be much greater than, for example, that associated with subacromial decompression. Post-operative requirements for analgesia would vary largely depending on the procedure performed. It would be useful to know and compare the distribution of procedures amongst each group as this would be a major confounding factor affecting the results. W. Jamil, Clinical Fellow - Orthopaedics, P. Monga, R. Jain, Wythenshawe Hospital, Manchester, UK.