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Peer review report 2 on “Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis”
International Journal of Surgery 37 Supplement 1 (2017) S502
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Peer Review Report
Peer review report 2 on “Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis” 1. Original submission 1.1. Recommendation Major Revision.
1.2. Comments to the author Thank you for the opportunity to review this manuscript. I have made some comments below: Abstract. 1. Accurately reflects the study. Introduction 1. Several sentences need re-written to correct grammatical errors 2. The authors discuss the evidence around Bupivacaine, however, they should also discuss the limitations of the evidence which prompts the meta-analysis. 3. The research question is not clear. Efficiency and safety are not robust, reliable and reproducible outcome measures and this needs to be addressed. This is particularly important as the results section details several outcome measures. Therefore, the study does not read as a focussed study and this should be addressed. Methods 1. Generally the methodology appears robust with clear inclusion, exclusion and selection criteria. 2. The quality assessment paragraph slips into the first person and a consistent style should be used. 3. The GRADE system should be referenced 4. The authors should state when they used the random-effects and fixed-effects models. 5. The outcome measures chosen should be justified. For example, why use the ‘VAS’ scale over other possible scales.
DOI of published article: http://dx.doi.org/10.1016/j.ijsu.2017.08.569. http://dx.doi.org/10.1016/j.ijsu.2017.08.572 1743-9191
Results 1. The results section should be condensed and an overall picture of the results given. To some extent, the manuscript reads like a postgraduate research thesis rather than a commentary of the results of a study. 2. There are several Forrest plots and these need to be condensed. It may be better to place less important figures in a supplementary data section for online review. 3. The main limitation of the study is the number of studies identified and the heterogeneity in the treatments received. For example, the other treatments received varied in volume of local anaesthetic and whether epinephrine was used. This makes interpreting the results very difficult. It could be argued that they are not massively different and therefore this is a limitation of the study, however, they are not identical to allow the undertaking of a met analysis. A strength could be the systematic review and how this could drive a prospective study with best available alternative based on volume and concentration of local anaesthetic. Discussion 1. Although the discussion is well written and argued, there are several limitations of the study that make interpreting the importance of the results difficult. 2. The authors state the sample size is small, but what is the effect of the metanalysed data? Is the sample size created by the metanlaysis sufficient to answer a particular research question? This would involve identifying/detailing a clinically relevant magnitude of difference. The authors should discuss this as it could make their met analysis useful for planning an appropriately powered study with specified treatment arms. 3. I don't think it can be argued that no difference is the same as equal and the authors would need to detail a power calculation to support this argument. Arfon Powell Cardiff University, Institute of Cancer and Genetics, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Peer Review Report
Peer review report 2 on “Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis” 1. Original submission 1.1. Recommendation Major Revision.
1.2. Comments to the author Thank you for the opportunity to review this manuscript. I have made some comments below: Abstract. 1. Accurately reflects the study. Introduction 1. Several sentences need re-written to correct grammatical errors 2. The authors discuss the evidence around Bupivacaine, however, they should also discuss the limitations of the evidence which prompts the meta-analysis. 3. The research question is not clear. Efficiency and safety are not robust, reliable and reproducible outcome measures and this needs to be addressed. This is particularly important as the results section details several outcome measures. Therefore, the study does not read as a focussed study and this should be addressed. Methods 1. Generally the methodology appears robust with clear inclusion, exclusion and selection criteria. 2. The quality assessment paragraph slips into the first person and a consistent style should be used. 3. The GRADE system should be referenced 4. The authors should state when they used the random-effects and fixed-effects models. 5. The outcome measures chosen should be justified. For example, why use the ‘VAS’ scale over other possible scales.
DOI of published article: http://dx.doi.org/10.1016/j.ijsu.2017.08.569. http://dx.doi.org/10.1016/j.ijsu.2017.08.572 1743-9191
Results 1. The results section should be condensed and an overall picture of the results given. To some extent, the manuscript reads like a postgraduate research thesis rather than a commentary of the results of a study. 2. There are several Forrest plots and these need to be condensed. It may be better to place less important figures in a supplementary data section for online review. 3. The main limitation of the study is the number of studies identified and the heterogeneity in the treatments received. For example, the other treatments received varied in volume of local anaesthetic and whether epinephrine was used. This makes interpreting the results very difficult. It could be argued that they are not massively different and therefore this is a limitation of the study, however, they are not identical to allow the undertaking of a met analysis. A strength could be the systematic review and how this could drive a prospective study with best available alternative based on volume and concentration of local anaesthetic. Discussion 1. Although the discussion is well written and argued, there are several limitations of the study that make interpreting the importance of the results difficult. 2. The authors state the sample size is small, but what is the effect of the metanalysed data? Is the sample size created by the metanlaysis sufficient to answer a particular research question? This would involve identifying/detailing a clinically relevant magnitude of difference. The authors should discuss this as it could make their met analysis useful for planning an appropriately powered study with specified treatment arms. 3. I don't think it can be argued that no difference is the same as equal and the authors would need to detail a power calculation to support this argument. Arfon Powell Cardiff University, Institute of Cancer and Genetics, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom