Correspondence  |   August 2016
In Reply
Author Notes
  • Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, Massachusetts; Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada (K.S.L.). karim.ladha@post.harvard.edu
  • (Accepted for publication April 28, 2016.)
    (Accepted for publication April 28, 2016.)×
Article Information
Correspondence
Correspondence   |   August 2016
In Reply
Anesthesiology 8 2016, Vol.125, 440-441. doi:10.1097/ALN.0000000000001192
Anesthesiology 8 2016, Vol.125, 440-441. doi:10.1097/ALN.0000000000001192
We would like to thank Schwenk et al. for their interest and comments related to our article.1  However, we believe that the objections raised are misguided, given the hypothesis being tested and the methods employed in our study.
In their letter, the authors state that it is only in combination with other multimodal analgesics that epidural analgesia would decrease the risk of persistent opioid use. Because we did not capture whether multimodal anesthesia was used, they argue that the entire premise of our study was flawed. While it is perhaps an interesting hypothesis that epidurals only decrease persistent opioid use when used in conjunction with other modalities, it is pure speculation. It does not make our study, which tested the hypothesis that epidurals decrease persistent opioid use, “flawed.” Epidurals are likely often used in conjunction with other analgesics (such as acetaminophen or nonsteroidal antiinflammatory drugs2 ), and if this combination were to decrease the risk of persistent opioid use, then there should have been some signal of benefit for epidurals (which, unfortunately, there was not).
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