Comment on “Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial”

Abstract

Dear Editor Recently, a randomized controlled study involving 160 participants investigated the efficacy of local anesthetic therapy in pain management after laparoscopic cholecystectomy [1]. In this study, the authors divided all patients into four groups based on the different use of local anesthesia, and found that perioperative local anesthetic administration was more efficient in preventing pain than the control group after laparoscopic cholecystectomy. In addition to reducing postoperative pain, these approaches also significantly lessened the requirement for postoperative analgesics and improved patient’s satisfaction after operation. Undoubtedly, this study provides important evidence for reducing pain after laparoscopic cholecystectomy and helps clinicians make appropriate choices. However, the following issues are worth pointing out. First, it should be mentioned that preoperative and postoperative treatment strategies for laparoscopic cholecystectomy are missing. Unquestionably, analgesic strategies after laparoscopic cholecystectomy were associated with postoperative pain and patient satisfaction. A meta-analysis [2] of four studies involving 263 participants exhibited that the use of magnesium sulfate remarkably reduced pain scores at 2 (P = 0.04) and 8 hours (P = 0.0003) after laparoscopic cholecystectomy, as well as the consumption of analgesic drug use, compared with conventional treatment group. Similarly, another meta-analysis [3] involving 5 studies also showed that intravenous lidocaine meaningfully reduced pain scores (including 12, 24 and 48 hours), and the consumption of opioid after laparoscopic cholecystectomy. Additionally, fewer adverse events were observed in the lidocaine group compared with the control group. Furthermore, another study [4] based on Iranian population indicated that intravenous paracetamol substantially reduced postoperative pain scores in patients underwent laparoscopic cholecystectomy. Those above evidences suggest that preoperative and postoperative analgesic strategies also play an important role in postoperative pain after laparoscopic cholecystectomy. Therefore, it is necessary to provide preoperative and postoperative treatment strategies, in order to obtain more accurate conclusions. Second, as described in this article that “All patients were assessed in terms of VAS scores, hemodynamic parameters, and patient satisfaction level (5: not satisfied, 1: highly satisfied) at postoperative 1, 2, 4, 6, 12, and 24 h and the result were recorded”, and we can know that the values of the above parameters (VAS scores, hemodynamic parameters, and patient satisfaction) were measured repeatedly at six different time points (postoperative 1, 2, 4, 6, 12, and 24 h) in this study. In this case, we can infer that the above variables belong to the continuous variables of repeated measurements, and repeated measures analysis of variance (ANOVA) or mixed-effects model repeated-measures analysis should be used to compare the differences among groups instead of one-way ANOVA. Since repeated measures ANOVA [5] or mixed-effects model repeated-measures analysis [6] not only considers the effect of different treatment strategies on the outcomes, but also take the effect of time factor into account, which is more helpful to accurately identify whether the change of difference among groups is caused by different treatment strategies or time factor. Funding source This work is Funded by Ningbo medical and health brand discipline. Provenance and peer review Commentary, internally reviewed. Declaration of competing interest None. Acknowledgment None.