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REPLY

CHUM – Hôtel-Dieu, Montreal, Canada, E-mail: pierre.beaulieu{at}umontreal.ca

Thank you to Dr. de Médicis and Dr. Tétrault for their interesting comments. While it is true that recruited patients in the referenced study underwent primarily gynecological and orthopedic procedures, the patients were distributed into four different groups, making it difficult to perform appropriate sub-group analysis with the limited number of subjects in each group.

The suggestion that more patients in the nabilone 2-mg group underwent knee arthroplasty is in fact, correct. Nevertheless, if excluding the three patients who underwent knee arthroplasty, the amount of morphine patient-controlled analgesia used in 24 hr (the primary outcome variable) in the nabilone 2-mg group was higher than previously reported (average of 49.5 mg compared to 45.4 mg, with no significant differences between the four groups). Furthermore, the intensity of pain at rest (24 hr), which was significantly different between groups, remained so, even if knee arthroplasty patients were excluded from the analysis. In contrast, when considering the pain scores on movement (24 hr), there were no statistical differences, although mean pain scores in the nabilone 2-mg group remained numerically greater, and only decreased from 7.7 to 7.1 (P = 0.09). Therefore, despite the fact that more patients in the nabilone 2-mg group underwent knee arthroplasty, this fact did not markedly influence pain scores which remained highest in this group, despite the similarity of morphine consumption in the two groups.

Related articles in CJA:

Cannabinoids for postoperative analgesia?

Étienne de Médicis and Jean-Pierre Tétrault
CJA 2007 54: 155. [Full Text]  

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