In reply: Postoperative pain and study design: the type of surgical procedure matters

Excerpt

Thank you for your interesting observations1 regarding our recent report.2 It is indeed challenging to do clinical studies in low-income countries (LICs). Regarding our definition of major surgery, the field has been fraught for more than half a century, but a recent study defined it as “… surgeries required general, epidural, or spinal anesthesia, and hospitalization for more than one day”.3,4 As to the “different pain intensities and temporal patterns” as well as controlling the analgesic regimens of this disparate group of participants, we were interested in looking at a treatment that might be applicable to postoperative pain control as it is actually practiced rather than a transitory ideal regimen that would disappear from practice as soon as the study was over. It is interesting that randomization placed no orthopedic participants in the placebo group. These painful procedures would almost certainly have made the pain score difference greater between the ketamine and placebo groups. We did not record a more detailed presentation of the surgical procedures. …