Comparative Analysis of Ketorolac and Parecoxib for Postoperative Pain Management in Uvulopalatopharyngoplasty

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

General Concept Comments

• Methodology: The study's design is robust, featuring random assignment and blinding which supports the validity of the results. However, the exclusion criteria may limit the generalizability to a broader patient population.

Specific Comments

Statistical Analysis (Lines 104-113): The authors utilized the paired t-test to evaluate postoperative pain scores among other variables. It is noted that no mention of normality tests for the data distribution was included prior to the application of the t-test. The t-test assumes that the data are approximately normally distributed within each group. Without performing tests of normality (such as the Shapiro-Wilk test or Kolmogorov-Smirnov test), there is a risk that this assumption may not hold, which could potentially invalidate the results. It would strengthen the manuscript if the authors either:

 

General Questions

• Data Interpretation: The conclusions drawn are consistent with the data presented, though the discussion could expand on potential limitations due to the study size and demographic constraints.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear editor,

I found the manuscript on the use of parecocib vs ketorolac for pain management after uppv interesting and useful. However I have several concerns

First of all, authors do not report the exact time the VAS have been administered to patients. Parecoxib is administered twice a day whereas ketorolac 3times a day. It is possible that their maximum effect differs during the hours of the day, particularly the first day days when their levels may not be stable.

2nd. Since the authors report that parecoxib has superior results in pain management they should provide more details on possible contraindications for this medication

3rd. VAS results usually do not follow a normal distribution. Thus, a non-parametric test is probably more appropriate instead of the t test used in the study. (Although, it is highly unlikely that a different statistical will provide different results because the p-values are quite low.)

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Hsieh and colleagues analyzed the intra- and postoperative analgesic management in patients who underwent UPPP. Ketorolac, a COX 1 and 2 inhibitor or Parecoxib, a selective COX 2 inhibitor were given to these patients in this single-blinded, randomised trial.  

I think it is of great value for otorhinolaryngologists performing the UPPP and their patients to know what medication is more effective and has less side effects. 

However, I have a few major concerns: 

Introduction:

1.       Ll. 31-32: Please add mild or moderate obstructive sleep apnea and please delete „removing or“.

2.       The Primary and secondary outcome measurements are missig. Please add.

 

Methods:

3.       Line 101: How much acetaminophen did all patients receive?

 

Results:

4.       Ll: 116-117: How long was your follow-up with no secondary bleedings? Bleedings can occur even 2-3 weeks after surgery.

5.        Table 1: Are the authors sure that they present data with 95% CI? Where can I find the 95% CI? Isn’t it the mean and SD?

6.       Line 125: Primary or secondary outcomes?

7.       Ll. 126-149: The authors do not need to write all numbers again as they can be found in table 2. It is sufficient to mention the main findings in the text without mentioning the exact numbers again.

8.       Table 3:

A)      Please write data are presented as number of patients (N) and percentages (%). Then „N (%)“ can be removed from the table.

B)      Why are the p-values missing further down?

C)      Please explain in the legend what do the authors mean with „postoperative day 1 …“?

9.       Ll. 159-162: In table 3 it is measured in days not hours.

Discussion:

10.   Could the authors please discuss the price (difference) of the two medications?

11.   Figure 1 and 2: There should be no figures/ new results in the discussion section. Please put this figure including the text explaining the main results of it in the results section.

12.   Line 188: The authors do not need to mention tables or figures again in the discussion.

13.   Ll. 216-220: In this study local anasthesia was not given postopeartively right?

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I thank the authors for addressing all my comments.