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Appropriate Discourse: Reply to Drs Smith and Barrington

To the Editor: In the interest of improved reporting of systematic reviews and meta-analyses in future issues of this journal, we are compelled to comment on the recent report by Hussain et al of a meta-analysis of 6 randomized controlled trials comparing adductor canal to femoral nerve blockade for total knee arthroplasty. A meta-analysis provides a means by which to aggregate information from multiple clinical studies leading to increased statistical power and a more robust point estimate compared with a measure derived from an individual study. The quality of the meta-analysis performed is dependent on the scope and quality of the studies sourced, as well as the analysis type performed, which should take into account confounding factors such as risk of bias. It is for this reason that the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and subsequent guidelines were developed. PRISMA set out an evidencebased minimum set of items for reporting in systematic reviews and meta-analyses, providing an assessment instrument that