Jose, Jes1; Magoon, Rohan2; Suresh, Varun3,
1Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
2Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
3Department of Anesthesia and Intensive Care, Jaber Al Ahmad Al Sabah Hospital, Kuwait City, Kuwait
Address for correspondence: Dr. Varun Suresh, Department of Anesthesia and Intensive Care, Jaber Al Ahmad Al Sabah Hospital, Kuwait-Arabian Gulf, Kuwait. E-mail: [email protected]
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To The Editor,
We wholeheartedly congratulate Bakeer et al.[1] for their article published recently in the Bali Journal of Anesthesiology. The authors outline a superior analgesic profile of erector spinae plane block (ESPB) compared to transversus abdominis plane block (TAPB) in their randomized evaluation of 62 cancer patients undergoing abdominal surgery laparotomies. With the primary objective of studying the mean 24-h postoperative morphine requirements, the research group bases their sample size on a study by Kumar et al.[2] That being said, it needs to be emphasized that the latter study administered 1-mg morphine in the face of a postoperative pain score >4, whereas Bakeer et al.[1] administered 2-mg morphine subsequent to the documentation of a pain score >3. Indeed, the present study demonstrated a higher postoperative morphine consumption in their TAPB group, in contrast to the Kumar et al.[2] study (8.52 ± 3.35 versus 5.65 ± 1.55 mg). Meanwhile, Kumar et al.[2] employed 20 mL of 0.25% ropivacaine on each side; we seek the authors’ response on the local anesthetic drug-dose-volume used in their setting. Additionally, the delineation of a reduced intraoperative fentanyl requirement in the ESPB group as opposed to the TAPB group, in the absence of a defined indication for intraoperative opioid supplementation in the index study, is far from being holistic and simultaneously prone to the influence of practice variability.[1,3] It is equally relevant to know if the included patients were subjected to a formal depth of anesthesia monitoring.[4] We sincerely believe that the authors’ clarification of our observations could assist the readers of the Journal comprehend their research findings with augmented clarity.
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Conflicts of interest
There are no conflicts of interest.
References
1. Bakeer AH, Hamimy W, Zaghloul A, Shaban A, Magdy M, Ahmed MB. Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block in laparotomies for cancer surgeries: A randomized blinded control study. Bali J Anaesthesiol 2023;7:19-23
2. Kumar GD, Gnanasekar N, Kurhekar P, Prasad TK. A comparative study of transversus abdominis plane block versus quadratus lumborum block for postoperative analgesia following lower abdominal surgeries: A prospective double-blinded study. Anesth Essays Res 2018;12:919-23
3. Magoon R. Implications of practice variability: Comment. Anesthesiology 2020;133:943-4
4. Bruhn J, Myles PS, Sneyd R, Struys MM. Depth of anaesthesia monitoring: what’s available, what’s validated and what’s next?. Br J Anaesth 2006;97:85-94
