LAUSR

To the Editor, We read with great interest the article by Ibrahim et al. (2019) in a recent issue of the journal. The authors performed a randomized clinical trial in 60 patients undergoing arthroscopic anterior cruciate ligament reconstruction and concluded that the addition of dexamethasone to bupivacaine in adductor canal block provides prolonged post‐operative analgesia and less post‐operative analgesic consumption than bupivacaine alone. The authors should be congratulated for performing a well‐designed study in an important topic (e.g., acute pain) in patients undergoing elective surgery (Chen, Tang, Zhang, Jiang, & Liu, 2017; Oda, Izumi, Aso, & Ikeuchi, 2018). The need to improve post‐operative recovery by reducing moderate to severe post‐operative pain makes the topic very important in perioperative medicine (Burkle, Olsen, Sviggum, & Jacob, 2017; Shick, Lebovitz, & Conrad, 2017). Although the study was well conducted, there are some critical points that need to be clarified by the authors. First, the trial registration states that opioid consumption is a secondary outcome measure; however, the authors did not report on opioid consumption in their data results. Second, the authors performed multiple analyses, but did not adjust their analysis for type I error. Finally, it is unclear on who collected the data regarding to pain scores. Pain scores obtained by clinical nurses have been shown to be biased for analgesic studies, and this may have contributed for additional biases in the study results (McCarthy & De Oliveira, 2015). We would welcome comments by the authors as this would further support the findings of this important clinical trial.