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In Reply: In response to Drs Jankowski and Warner, a statistically significant difference is more likley to be obtained when analyzing larger numbers of patients. In our case, the overall difference between opioid and epidural analgesia represented an approximate 30% difference. When assessed over the entire range (10%-75%) and compared with patient-derived measures of clinically important differences, an approximate 33% reduction in pain intensity appears to be the optimal and clinically meaningful cutoff.^1-2 In addition, another article published after ours also suggested that an approximately 35% decrease in acute pain scores is clinically meaningful.³ As more studies are published, an updated analysis comparing the 2 regimens would be appropriate.

We agree that extremely aggressive pain management might diminish the differences in pain scores between parenteral opioids and epidural analgesia. This might be especially true for PCA. In fact, aggressive pain management has been reported to result in similar pain scores . . . [Full Text of this Article]

Christopher L. Wu, MD
chwu@jhmi.edu

Brian M. Block, MD, PhD; Andrew J. Rowlingson, BA
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins University
Baltimore, Md

Spencer S. Liu, MD
Department of Anesthesiology
Virginia Mason Medical Center
University of Washington
Seattle

Anne R. Cowan, MD
Department of Anesthesiology

John A. Cowan, MD
Department of Neurosurgery
University of Michigan
Ann Arbor

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