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Parenteral vs Epidural Analgesia for Postoperative Pain
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To the Editor: In their meta-analysis, Dr Block and colleagues1 concluded that epidural analgesia provided improved postoperative pain control compared with parenteral opiates, as indicated by a summary difference of 10 mm on a 100-mm visual analogue scale (VAS). We have several concerns about their methods.
First, we question the clinical significance of a 10-mm difference in VAS, especially given the relatively low baseline values of the VAS.
Second, we disagree with the authors' strategy of computing a summary effect for all forms of parenteral opiate analgesia. In fact, intravenous patient-controlled analgesia (PCA) opiate analgesia is generally regarded as better than other forms of parenteral opiate analgesia.2 This, and the prevalence of PCA analgesia in current medical practice, would make comparisons involving this mode of parenteral opiate administration more relevant. Although the authors mentioned that they did perform this analysis and that the results were no different than the primary . . . [Full Text of this Article]
Christopher J. Jankowski, MD
jankowski.christopher@mayo.edu
David O. Warner, MD
Department of Anesthesiology
Mayo Clinic College of Medicine
Rochester, Minn
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