This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kehlet, H. Search for Related Content PubMed PubMed Citation Articles by Kehlet, H.

---

LETTER TO THE EDITOR

Postoperative Analgesia and Hospital Stay: A Call for Better Study Design

Section for Surgical Pathophysiology 4074, The Juliane Marie Centre, Rigshospitalet, Blegdamsvej 9, Denmark, henrik.kehlet{at}rh.dk

To the Editor:

Salinas et al. (1) recently reported a randomized study comparing single-injection femoral nerve block versus a continuous technique for total knee arthroplasty. They concluded that the continuous technique improved analgesia with minimal impact on hospital stay and long-term functional recovery. Although they should be congratulated for their analgesic data, it is questionable whether their conclusions about hospital stay are supported by their data. The discharge criteria were vague. The time course for repeated assessment was not described.

It has been emphasized (2) that a key question in outcome studies is a daily recording of factors precluding discharge. In the study by Salinas et al. (1), there is no information on the factors precluding earlier discharge, and therefore the possibility remains that discharge was dependent on factors other than pain management, such as tradition and organization. This is particularly relevant because other data suggest shorter hospitalization with a continuous peripheral block technique (3).

Future studies evaluating the influence of perioperative management, including pain management, must incorporate a better design to permit proper analysis of the relationship between perioperative interventions and duration of hospitalization.

REFERENCES

1. Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg 2006;102:1234–9.[Abstract/Free Full Text]
2. Kehlet H. Post-operative pain relief–a look from the other side. Reg Anesth 1994;19:369–77.[Web of Science][Medline]
3. Ilfeld BM, Gearen PF, Enneking FK, et al. Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study. Anesth Analg 2006;102:87–90.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kehlet, H. Search for Related Content PubMed PubMed Citation Articles by Kehlet, H.