The Authors Reply

Excerpt

To the Editor— The authors thank Mr. Lee and Professor Phillips for their kind comments and answer their queries. We agree that multimodal anesthesia conveys analgesic advantages to the patient undergoing major surgery and is becoming more widespread. Therefore, where regional anesthesia is available, and if it is considered standard of care, omission in a trial becomes an ethical question. Twenty-three of 60 patients in our trial were American Society of Anesthesiologists Grade 2 or 3, and a total of two significant respiratory tract infections occurred (i.e. , approximately <4 percent). We do not believe this to be excessive. Some words of caution to our colleagues who assume that perioperative/postoperative epidural analgesia reduces respiratory complications: well-powered, randomized, controlled trials demonstrate no significant effects on overall morbidity and only a modest reduction in the incidence of respiratory failure in high-risk patients.1,2 …