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Peer review report 3 on “Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty: A meta-analysis”
International Journal of Surgery 37 Supplement 1 (2017) S488
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Peer Review Report
Peer review report 3 on “Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty: A metaanalysis” 1. Original submission 1.1. Recommendation Major Revision. 1.2. Comments to the author Reviewers' comments: International Journal of Surgery Manuscript Draft. Manuscript Number: IJS-D-17-00419. Title: Comparison of femoral nerve block and fascia iliaca block for pain control in total joint arthroplasty: a meta-analysis from randomized controlled trials Article Type: Systematic review and/ or Meta-analysis. Hip and knee arthroplasty are elective common orthopedic procedures. The numbers will most certainly increase with increasing mean age and BMI. Effective and safe pain management enabling rapid rehabilitation is essential. Multimodal analgesia, combining none-opioid analgesics e.g. paracetamol/NSAIDs, loco/regional anaesthesia and merely provide “rescue postoperative opioid” has become standard of care. The optimal protocol; what drugs and doses, loco/regional anaesthetic technique and timing is however not well defined. The present meta-analysis focuses, assess the difference between femoral nerve block and fascia iliaca block as the regional block technique for postoperative pain in patient having undergone hip or knee replacement in general anaesthesia.
DOI of published article: http://dx.doi.org/10.1016/j.ijsu.2017.08.008. http://dx.doi.org/10.1016/j.ijsu.2017.08.014 1743-9191
It shows no difference in VAS scores or opioid consumption during the 1st 48 postoperative hours. This is important information, however the number of studies, number of included are low. The local anaesthetic used and dose/ volume differs to major extent as do the multi-modal regime. It seems of importance to separate the procedures, analyze hip and knee independent. The technique used, ultra-sound or nerve stimulator or “blind” needs to be presented. Timing for block should be presented, prior to, end of surgery or after surgery. Was any additional local anaesthesia, e.g. local infiltration given prior to or after completion of surgery. How was transition for GA to postoperative pain management managed, did patients have an end of surgery opioid dose? It seems of importance as addressed in the limitation section to state that further studies are warranted, the matrix, how to build an optimal multi-modal analgesia protocol is not uncomplicated. A sequential approach is probably needed. A protracted and extensive assessment of Quality of Recovery would have been of huge interest. Jan G. Jakobsson Karolinska Institute Physiology & Pharmacology, Anaesthesia, Dept Anaesthesia, Danderyds University Hospital, Stockholm, Stockholm 18288, Sweden E-mail address: [email protected].
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Peer Review Report
Peer review report 3 on “Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty: A metaanalysis” 1. Original submission 1.1. Recommendation Major Revision. 1.2. Comments to the author Reviewers' comments: International Journal of Surgery Manuscript Draft. Manuscript Number: IJS-D-17-00419. Title: Comparison of femoral nerve block and fascia iliaca block for pain control in total joint arthroplasty: a meta-analysis from randomized controlled trials Article Type: Systematic review and/ or Meta-analysis. Hip and knee arthroplasty are elective common orthopedic procedures. The numbers will most certainly increase with increasing mean age and BMI. Effective and safe pain management enabling rapid rehabilitation is essential. Multimodal analgesia, combining none-opioid analgesics e.g. paracetamol/NSAIDs, loco/regional anaesthesia and merely provide “rescue postoperative opioid” has become standard of care. The optimal protocol; what drugs and doses, loco/regional anaesthetic technique and timing is however not well defined. The present meta-analysis focuses, assess the difference between femoral nerve block and fascia iliaca block as the regional block technique for postoperative pain in patient having undergone hip or knee replacement in general anaesthesia.
DOI of published article: http://dx.doi.org/10.1016/j.ijsu.2017.08.008. http://dx.doi.org/10.1016/j.ijsu.2017.08.014 1743-9191
It shows no difference in VAS scores or opioid consumption during the 1st 48 postoperative hours. This is important information, however the number of studies, number of included are low. The local anaesthetic used and dose/ volume differs to major extent as do the multi-modal regime. It seems of importance to separate the procedures, analyze hip and knee independent. The technique used, ultra-sound or nerve stimulator or “blind” needs to be presented. Timing for block should be presented, prior to, end of surgery or after surgery. Was any additional local anaesthesia, e.g. local infiltration given prior to or after completion of surgery. How was transition for GA to postoperative pain management managed, did patients have an end of surgery opioid dose? It seems of importance as addressed in the limitation section to state that further studies are warranted, the matrix, how to build an optimal multi-modal analgesia protocol is not uncomplicated. A sequential approach is probably needed. A protracted and extensive assessment of Quality of Recovery would have been of huge interest. Jan G. Jakobsson Karolinska Institute Physiology & Pharmacology, Anaesthesia, Dept Anaesthesia, Danderyds University Hospital, Stockholm, Stockholm 18288, Sweden E-mail address: [email protected].