Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
Wu CL, Block BM, Rowlingson AJ, Liu SS, Cowan AR, Cowan JA. Parenteral vs Epidural Analgesia for Postoperative Pain—Reply. JAMA. 2004;291(10):1197-1198. doi:10.1001/jama.291.10.1198-a