LAUSR

Dear Sir, We read with great interest the article “Perioperative pain management after fibular free flap harvesting for head-and-neck reconstruction using mini-catheters to inject local anesthetic: A pilot study” in a recent issue of the journal (Ferri et al., 2018). The authors performed a prospective study on 31 patients treated for head and neck reconstruction with fibula free flap using mini-catheters for local anesthetic injection in the early postoperative time and concluded that minicatheters seems to be easy, safe, and efficient when used to control pain after fibular free-flap harvesting. The authors should be congratulated for performing a study in an important topic (eg, acute pain) in patients undergoing surgery (Broyles et al., 2016; Kıtlık et al., 2017). The current emphasis on the need to use local anesthetics to improve postoperative outcomes makes the topic very relevant in perioperative medicine (Chong, Wang, Dhir, & Lin, 2017; Kumar, Bullock, & Dooley, 2017). Although the study of Ferri et al. was well conducted, there are some questions regarding the study that need to be clarified. First, it is not clear whether the intraoperative and postoperative analgesic techniques were standardized for all patients as this can substantially alter the outcomes. Second, it seems that the pain scores were high (8 out of 10) for some patients and it would be interesting if the authors could explain the high variability of the pain scores reported. Last, one of the major obstacles with pain catheters is catheter dislodgement, but the authors do not report if they observed this complication. We would welcome some comments to address the aforementioned issues as they were not discussed by the authors. This would help to further support the findings of this important study.