505986
research-article2013
FAIXXX10.1177/1071100713505986Foot & Ankle International
Letters to the Editor Foot & Ankle International 34(12) 1749 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100713505986 fai.sagepub.com
Author Response
Dear Editor, We thank Dr. Hsu for his lengthy assessment of our study, which brings up several important issues. We were also concerned about the potential for the anti-inflammatory medications used to impair healing of the fusions. As part of a companion study (not yet published) in this study group, we examined the fusion healing rates specifically as they related to the administration of celecoxib or naproxen. In both univariate and multivariate analysis, neither medication was associated with lower healing rates. In addition, the overall healing rates were similar between the multimodal treatment group and those receiving traditional perioperative analgesia. We completely agree that the benefit of the multimodal pain protocol is a consequence of the synergistic effects of the medications that interdict the pain-generation pathway at multiple points, as originally proposed
by Kehlet and Dahl in 1993.1 It is equally clear that this subject will benefit from further research that explores the efficacy of specific medication combinations and assesses the potential adverse side effects (such as impaired osteogenesis). James D. Michelson, MD Raymond A. Addante, BA Mark D. Charlson, MD Department of Orthopaedics and Rehabilitation, University of Vermont School of Medicine, Burlington, VT, USA Reference 1. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048-1056.
Downloaded from fai.sagepub.com at NORTHERN ARIZONA UNIVERSITY on June 16, 2015
research-article2013
FAIXXX10.1177/1071100713505986Foot & Ankle International
Letters to the Editor Foot & Ankle International 34(12) 1749 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100713505986 fai.sagepub.com
Author Response
Dear Editor, We thank Dr. Hsu for his lengthy assessment of our study, which brings up several important issues. We were also concerned about the potential for the anti-inflammatory medications used to impair healing of the fusions. As part of a companion study (not yet published) in this study group, we examined the fusion healing rates specifically as they related to the administration of celecoxib or naproxen. In both univariate and multivariate analysis, neither medication was associated with lower healing rates. In addition, the overall healing rates were similar between the multimodal treatment group and those receiving traditional perioperative analgesia. We completely agree that the benefit of the multimodal pain protocol is a consequence of the synergistic effects of the medications that interdict the pain-generation pathway at multiple points, as originally proposed
by Kehlet and Dahl in 1993.1 It is equally clear that this subject will benefit from further research that explores the efficacy of specific medication combinations and assesses the potential adverse side effects (such as impaired osteogenesis). James D. Michelson, MD Raymond A. Addante, BA Mark D. Charlson, MD Department of Orthopaedics and Rehabilitation, University of Vermont School of Medicine, Burlington, VT, USA Reference 1. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048-1056.
Downloaded from fai.sagepub.com at NORTHERN ARIZONA UNIVERSITY on June 16, 2015
