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Strategies to Reduce Pain After Laparoscopic Gynecologic Surgery.

In Reply: We regard it a great honor to respond to the letter by Dr Kendall who poses the question: If authors had a standardized intraoperative analgesic regimen? Yes. We usually use 2mg midazolam and 0.2 μg/kg fentanyl for premedication. Thereafter, the patients are intubated using 1 to 2.5mg/kg propofol and 0.5mg/kg Atracurium. Propofol and fentanyl were used for maintenance. Although there are reports that propofol has an influence on pain reduction after laparoscopic surgery,1,2 we used it for both groups, which naturalized its possible pain reduction effect and confounding role. Moreover, the anesthesiologist was blinded about our decision to use the drain or not, anyway. We used ondansetron as the prophylaxis regimen for postoperative nausea and vomiting. There is no report about pain alleviation with ondansetron despite the use of dexamethasone.3,4 The standard way to protect a trial against ascertainment bias is by keeping the people involved in the trial blind to the identity of the interventions as long as it is possible. This strategy can be applied during at least 2 steps of a trial: at the time of data collection (from the administration of the interventions to the gathering of outcome data) and after data collection (data analysis and results reporting).5,6 We did not reveal the target intervention for nurses, and they were blinded to the study design. McCarthy and De Oliveira7 reported in their study that nurses are not reliable sources for data collection, which leads to anesthesiologist evaluation. In such studies, conflict of interests and other biases could interfere with results. However, this study design is different. Indeed, usually in research programs, nurses are effective and active members of the research team. We thank Dr Kendall for stimulating this discussion.