Our review revealed a great heterogeneity in definition , format , and values of what is considered a clinical ly relevant difference in pain in RCTs of analgesics , and st and ardizations are advisable
OBJECTIVE To describe the  pain decrease considered as clinical ly relevant when design ing a trial and reporting its results .
Perioperative Nimodipine and Postoperative Analgesia
There is experimental evidence that nimodipine , an L-type dihydropiridine calcium channel blocker with relatively high blood-brain barrier penetration , enhances the antinociceptive properties of morphine . We tested the hypothesis that oral nimodipine taken preoperatively and 6 hourly for 48 h postoperatively would reduce visual analog scale pain scores and morphine consumption in morphine-naive patients with acute postoperative pain . Forty patients undergoing total knee replacement surgery ( age 70 ± 7 yr , 28 male ) were r and omized by computer-generated numbers to receive capsules containing either nimodipine 30 mg or placebo in a double-blind study design . All patients received 3 capsules ( nimodipine 90 mg or placebo ) 1–2 h before induction of anesthesia followed by oral nimodipine 30 mg or placebo 6 hourly for 48 hours postoperatively . Spinal anesthesia was induced with hyperbaric bupivacaine 0.5 % ( 2.4–3.0 mL ) and fluids and ephedrine were given at the discretion of the anesthesiologist . Morphine patient-controlled analgesia ( PCA , bolus 1 mg , lockout 5 min ) was given for postoperative analgesia . Primary outcome measures were visual analog pain scores at rest and on moving ( sitting forward ) and PCA morphine consumption . Morphine consumption was significantly larger in nimodipine patients at 12 h ( 39 ± 18 versus 29 ± 15 ; P = 0.04 ) , 24 h ( 62 ± 23 versus 45 ± 24 ; P = 0.02 ) , and 48 h ( 88 ± 34 versus 61 ± 27 ; P = 0.01 ) . There were no significant differences in pain scores at rest or moving or in time to first use of morphine analgesia . This study has demonstrated increased morphine consumption after 12 h in postoperative patients receiving nimodipine , suggesting that , in patients undergoing knee replacement surgery , it has no adjunctive analgesic effect and may actually inhibit the analgesic effect of morphine
Our review revealed a great heterogeneity in definition , format , and values of what is considered a clinical ly relevant difference in pain in RCTs of analgesics , and st and ardizations are advisable
OBJECTIVE To describe the  pain decrease considered as clinical ly relevant when design ing a trial and reporting its results .