Does Addition of Multipoint Rectus Sheath Block to Multimodal Analgesia Really Improve Postoperative Pain and Outcomes of Patients Undergoing Laparoscopic Colorectal Surgery?

Abstract

To the Editor-In the recent article by Yang et al, 1 the authors assessed the analgesic efficacy of adding multipoint rectus sheath block to the multimodal analgesic strategy after laparoscopic colorectal surgery. The mean between-group differences of 0.7 and 0.8 in the numerical rating scale (NRS) score of rest and activity pain levels were used as effectors of sample size evaluation based on their preexperiment results. However, when assessing the clinical utility of an intervention or therapy intended to improve patient outcomes, the amount of improvement that is important to patients has to be determined. Thus, a clinical trial is often required to use the minimal clinically important difference (MCID) of the primary outcome to evaluate the sample size and determine whether the between-group difference of the primary outcome is clinically significant. 2 The available literature recommends that the MCID for change of pain intensity produced by an intervention is a reduction of 1.5 points on a 0 to 10 NRS. 3 In light of the above-recommended MCID, we argue that the between-group differences of NRS rest and activity pain scores at most time points after surgery in this study achieved statistical significance, but none of them was clinically significant. Furthermore, this study showed that the other important outcomes of patient comfort deemed by the Standardized Endpoints in Perioperative Medicine initiative, that is, the time to first mobilization and time for the return of bowel function, 4 were not significantly different between groups. In these cases, we wonder whether adding a multipoint rectus sheath block to the multimodal analgesic strategy can improve the postoperative experience and outcomes of patients undergoing laparoscopic colorectal surgery.