Perioperative Analgesia in Crisis Situations: Patient Characteristics in COVID-19 from the PAIN OUT Registry

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

The authors have effectively addressed the reviewers' suggestions, making significant improvements to the manuscript. I have no further suggestions.

Author Response

Thankfully

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

After reading the article PERIOPERATIVE ANALGESIA IN CRISIS SITUATION SARSCoV-2. Patient Characteristics in COVID-19 in PAIN OUT Registry, I found the idea interesting, however, it suggests that the authors structure it in a way that makes it more understandable, check the journal's author guide carefully, check the writing. After restructuring the information, I suggest that you submit it again. There are words in spanish

Comments on the Quality of English Language

Extensive editing of English language required.

Author Response

One of the authors is living in England. She has reviewed the manuscript. We can´t found the spanish words. Could you please sign those, please?

Reviewer 3 Report (Previous Reviewer 4)

Comments and Suggestions for Authors

The Autors adressed the recomandations

Author Response

Thankfully

Round 2

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

The authors have adequately implemented the suggestions made in the previous reviews. The manuscript has improved greatly.

In the materials and methods section, I suggest that the subtitle analysis of results be included in the corresponding paragraphs.

Author Response

As reviewer suggested, the subtitle analysis is included y material and Methods section.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Editor and Authors,

 

I would like to express my gratitude for the opportunity to review this manuscript 

 

While SARS-CoV-2 is no longer a highly topical subject, the study offers some interesting insights into analgesia and postoperative pain management and other related surgical variables. However, there are several issues and flaws in the manuscript that need to be addressed before it can be considered for publication.

 

Title:

The title is not clear and should be rewritten to avoid using all capital letters. Consider a more precise title such as “Perioperative Analgesia in Crisis Situations: Patient Characteristics in COVID-19 from the PAIN OUT Registry.”

 

Sample Size Clarification:

The authors should clarify how the sample size was determined and whether it was sufficient to detect meaningful differences between the groups.

 

Tables:

The tables are overly detailed and could be summarized for clarity. Tables directly extracted from SPSS should be refined to include only the essential data and any Spanish text should be removed. Additionally, other tables, such as Table 5, need to be improved for better presentation.

 

Explanation of Metrics:

There is a lack of explanation for the observed differences in some metrics, such as the higher incidence of certain side effects in COVID-19 patients. This needs to be addressed.

 

Standardization of Terms:

The terms used throughout the manuscript should be standardized. For instance, "PainOut" and "PAIN OUT" should be consistently referred to in a single format.

 

Discussion:

The discussion section needs to be rewritten as it currently focuses on the outdated topic of COVID-19 rather than on perioperative analgesia and other studied surgical variables. The authors should explore potential mechanisms explaining why COVID-19 patients experience greater pain and adverse effects.

Multimodal perioperative analgesic strategies are only mentioned in the conclusions. These should be discussed more thoroughly in the main text, backed by the best available evidence.

 

Likert scales typically have five evaluation points, not four. Please justify the use of a four-point scale in this study.

 

Table Legends:

The legends for the tables are incomplete and should provide sufficient information for the reader to understand the data presented.

 

 

Comments on the Quality of English Language

English Language and Grammar:

The manuscript contains several grammatical errors and is difficult to understand in parts. For example:

“The study aimed at investigating” should be “The study aimed to investigate.”

“The data was” should be “The data were.”

“This fact is by Arevalo-Rodriguez et al´s article, where they included 34 studies enrolling 12,057 COVID-19 confirmed cases” could be improved to: “This information is derived from the study by Arevalo-Rodriguez et al., which included 34 studies encompassing a total of 12,057 confirmed COVID-19 cases.”

Overall, the manuscript has potential but requires significant revisions for clarity, grammar, and content relevance before it is suitable for publication.

Reviewer 2 Report

Comments and Suggestions for Authors

After reading the article PERIOPERATIVE ANALGESIA IN CRISIS SITUATION SARSCoV-2. Patient Characteristics in COVID-19 in PAIN OUT Registry, I found the idea interesting, however, it suggests that the authors structure it in a way that makes it more understandable, check the journal's author guide carefully, check the writing. After restructuring the information, I suggest that you submit it again.

Comments on the Quality of English Language

Extensive editing of English language required

Reviewer 3 Report

Comments and Suggestions for Authors

This study evaluates analgesic practices in COVID-19 and non-COVID-19 patients using the PAIN OUT database. The research aims to extract information on pain treatment, pain intensity, and infection severity to analyze differences in postoperative pain and pain management between non-COVID-19 and COVID-19 patients. This study is expected to be beneficial in providing information on postoperative pain and establishing pain management guidelines for patients requiring surgery during future pandemics. However, significant revisions are needed before the paper can be published.

 

 

Major Comments

As mentioned earlier, this paper aims to analyze the patterns of postoperative pain and pain management methods used in COVID-19 patients compared to non-COVID-19 patients to evaluate pain management practices before and after surgery during the COVID-19 pandemic. However, the content of the paper mainly focuses on patient characteristics (type of surgery, COVID-19 diagnosis results, risk factors, medications taken) and contains little information related to the paper's purpose.

 

In Table 5, the use of opioids and NSAIDs is statistically significantly higher in patients not infected with COVID-19. How should this be interpreted? Does it suggest that COVID-19 patients have a lower likelihood of experiencing postoperative pain?

 

Minor Comments

There are typographical errors.

Table 4: Is "media" supposed to be "median"?

Table 5: "p" should be "P value"

Page 8 line 162-163:  p<0.001, p<0.05; not understandable

 

Reviewer 4 Report

Comments and Suggestions for Authors

I thank the editor for the opportunity to review this article. Please consider the following recommendations:

Abstract: no information about control group. You could erase the numeric data at this stage and just compare with the control group

Introduction: please consider a more convincing explanation for why is so important the pain management in covid patients. What is the relationship? Are there any physiopathological interferences?

Lines 50-51 is exaggerated. There are no proofs this regard.

 

Materials and methods: no main and secondary outcomes were defined, but only an exhaustive table with a lot of conditions/variable? What did you want to track? What did you compare?

Results: the results section contradicts the abstract with regard to the patients enrolled. It is confusing how did you get 277 COVID patient from 2980 surgical covid patient. If so, it is very questionable the (very) high rate of exclusion. What is the relevance to mention all the 10702 COVID patients. Table 2 contents all kind of pathologies (and not limited to surgery). It is very confusing

Table 3- irrelevant for this study

Table 4 does not consider the patients after 30 June, which is discordant to the time period that you have chosen (June- december). Please add the rest as well.

Table 5 brings no information with regard to your title

Discussion section does not focus the main issues considered: pain management in covid vs. non covid

 

General comment: this manuscript is about everything related to covid. Please try to focus on few objectives that should be follow throughout the entire document. Otherwise it is very confusing and lacks novelty