Conflating effect size and minimal clinically important difference. Comment on Br J Anaesth 2021; 126: 1029–37

Myles, Paul S.; Myles, Daniel B.

doi:10.1016/j.bja.2021.09.018

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…In addition, the non-inferiority margin was selected with previous research comparing the use of LIA against placebo and genicular nerves block against LIA. This limit is below the clinician-perceived minimal clinically important difference recently reported by Laigaard et al [10,16,25,26]. Likewise, it has been suggested recently that quality of recovery measurement should be performed routinely [27].…”

Section: Discussionmentioning

confidence: 79%

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Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

et al. 2022

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Genicular nerves block is a promising technique to treat acute postoperative pain in total knee arthroplasty. Similar to surgeon-administered local infiltration analgesia, it targets sensory branches from the knee capsule, but through a selective ultrasound-guided injection that reduces local anaesthetic dose (150 ml ropivacaine 0.2% with local infiltration analgesia vs. 20 ml with genicular nerves block). This randomised non-inferiority trial compared the analgesic efficacy of genicular nerves block vs. local infiltration analgesia in the first 24 h following total knee arthroplasty. Sixty patients were randomly allocated to receive either ultrasound-guided block of five genicular nerves or local infiltration analgesia. The primary outcome was rest pain numeric rating scale (0-10) at 24 h. Secondary outcomes included pain numeric rating scale (rest and movement) and cumulative opioid consumption during the first 24 h. We analysed 29 patients in the genicular nerves block group and 30 in the local infiltration analgesia group. We found that the median difference (95%CI) in postoperative rest pain at 24 h (non-inferiority criteria, D = 1) was À1.0 (À2.0 to 1.0, p < 0.001). Median difference in cumulative opioid consumption was 0.0 mg (À3.0-5.0, p < 0.001) meeting the non-inferiority criteria, D = 23 mg. We conclude that genicular nerves block of five nerves provides non-inferior analgesia in the first 24 h following surgery compared with local infiltration analgesia, but with a considerable reduction in the local anaesthetic dose.

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Section: Discussionmentioning

confidence: 79%

“…This limit is below the clinician‐perceived minimal clinically important difference recently reported by Laigaard et al. [10, 16, 25, 26]. Likewise, it has been suggested recently that quality of recovery measurement should be performed routinely [27].…”

Section: Discussionmentioning

confidence: 83%

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

et al. 2022

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“…Laigaard et al concluded that median clinician-perceived MCIDs in postoperative pain management were 10 mg iv morphine equivalents or 40% of opioid consumption and 15-18 mm or 30% for pain scores ( 28 ). Different analgesia regimens enable most patients to be at low risk for moderate or severe pain ( 29 ). The use of rescue analgesics for a minor reduction in pain scores and opioid consumption has been dampening, and the patients with higher baseline pain scores may be more responsible for treatment effects ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks

Sreckovic,

Ladjevic,

Milicic

et al. 2024

Front. Med.

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IntroductionPeripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP).MethodsThis prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA.Results166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg).ConclusionPeripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.

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“…However, we disagree that the minimal clinically important difference (MCID) should dictate the effect size used in a sample size calculation for a clinical trial. 1 The chosen effect size should be clinically or scientifically meaningful, but it need not be the MCID. 2 In addition, the recommended MCIDs of 10 mg IV morphine reduction for 24 h is for total hip arthroplasty or total knee arthroplasty, 3 not for liver resection.…”

Section: Dear Editormentioning

confidence: 99%

Comparing Analgesic Efficacy of Regional Block Techniques After Laparoscopic Liver Resection: In Reply [Response to Letter]

Kang¹,

Ko²

2022

JPR

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Conflating effect size and minimal clinically important difference. Comment on Br J Anaesth 2021; 126: 1029–37

Cited by 7 publications

References 12 publications

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks

Comparing Analgesic Efficacy of Regional Block Techniques After Laparoscopic Liver Resection: In Reply [Response to Letter]

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