March 10, 2004

Parenteral vs Epidural Analgesia for Postoperative Pain—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(10):1197-1198. doi:10.1001/jama.291.10.1198-a

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.

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