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LETTER TO THE EDITOR

Early Termination Penalty

Centre hospitalier de l'Université de Montréal (CHUM); Hôpital St-Luc; Montreal; Quebec, Canada; luc.massicotte{at}umontreal.ca

In Response:

We thank Dr. Wax (1) for his interest in our work (2). From a strict epidemiological point of view, we should have the greatest possible number of patients enrolled for a study to be able to detect any rare side effects. To conduct a research project, we must respect some rules and our main hypothesis must be positive. Thus, when evaluating a new technique compared with a standard one, we hypothesize that this new technique should be superior to the standard one. We also have to determine the number of patients needed and the expected difference for the results to be significant. In our case, we knew that spinal morphine was superior to PCA alone. We wanted to know to what degree. We are aware that the number of patients reported from our study was small. Since that study, we have cared for more than 300 patients undergoing partial hepatectomy. Most of these patients received spinal morphine which is now routine practice in our institution. In each of these patients the trachea was extubated in the operating room a few minutes after the end of the surgery and no patient required reintubation of the trachea. The peak of action of spinal morphine in our study was 6 h postinjection. Our surgeries always last <6 h. If the surgery takes 6 h or more we are aware that extubation could be more hazardous because then respiratory depression is at its peak. Despite that, we prefer patients to be ventilated for a few hours in the PACU instead of giving less intrathecal morphine and having more pain for days.

REFERENCES

1. Wax D. Early termination penalty. Anesth Analg 2007;104:287.
2. Roy JD, Massicotte L, Sassine MP, et al. A comparison of intrathecal morphine/ fentanyl and patient-controlled analgesia with patient-controlled analgesia alone for analgesia after liver resection. Anesth Analg 2006;103:990–4.[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 Web of Science 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 Massicotte, L. Articles by Roy, A. Search for Related Content PubMed PubMed Citation Articles by Massicotte, L. Articles by Roy, A.