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LETTERS TO THE EDITOR

Combination Spinal Analgesic Chemotherapy: An Additional Clinical Trial of Opioid Plus Local Anesthetic

Department of Anesthesiology Department of Anesthesiology and Medicine, Tufts University School of Medicine and Tufts New England Medical Center, Boston, Massachusetts Department of Anesthesia and Pain Management, Royal North Shore Hospital and University of Sydney Sydney, Austrialia

To the Editor:

In the 4 months since our systematic review of combination spinal analgesic chemotherapy (1) appeared in Anesthesia & Analgesia, we have learned of one (and only one) published paper that we overlooked despite its having met inclusion criteria. Our failure to cite this paper was purely an oversight due to human error, which we regret—particularly since it reported on a well-designed and well-executed study. Crews et al. (2) conducted this prospective, randomized, double-blinded controlled trial to evaluate the effect of thoracic epidural administration of levobupivacaine 0.25% and morphine 0.005% alone or in combination for postoperative analgesia after major abdominal surgical procedures. Patients in the combination group had longer times to request supplemental ketorolac analgesia than the levobupivacaine-only group (P< 0.05), and a similar trend compared with the morphine-only group (P= 0.066). Patients in the combination group also had lower visual analog pain intensity scale scores at rest and activity at 4 and 8 h postoperatively, and fewer requests for supplemental ketorolac (P< 0.05). In summary, the authors found "improvement in postoperative analgesic efficacy...with the combination...as compared with either drug used alone" (2). Thus, inclusion of this study increases from 4 to 5 the number of retrieved trials in patients with acute pain that "support improved analgesic efficacy with the combination of a local anesthetic and an opioid compared with either drug administered alone" (1).

References

1. Walker SM, Goudas LC, Cousins MJ, Carr DB. Combination spinal analgesic chemotherapy: a systematic review. Anesth Analg 2002; 95: 674–715.[Free Full Text]
2. Crews JC, Hord AH, Denson DD, Schatzman C. A comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery. Anesth Analg 1999; 89: 1504–9.[Abstract/Free Full Text]

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