Efficacy and safety of intrathecal diamorphine: replies

Abstract

We thank Drs Xu and Rong [1] and Drs Leslie and Stranix [2] for their comments regarding our systematic review and meta-analysis exploring the efficacy and safety of intrathecal diamorphine [3].

Drs Xu and Rong correctly highlighted that the figure we initially presented regarding the risk of bias assessment of the included trials was not derived from the Cochrane Collaboration's Risk of Bias tool 2 (RoB2) [1], but rather RoB1. Whilst this was an oversight, and represents an educational opportunity for many readers, we fully agree with their observation and are pleased to now present the appropriate figure (Fig. 1) for included studies (online Supporting Information Appendix S1).

Drs. Leslie and Stranix share their experience with intrathecal diamorphine, reporting doses ranging from 0.4 to 1.0 mg with good efficacy and a 10% incidence of postoperative nausea and vomiting [2]. While they acknowledge the need for further trials, they also note the challenge of convincing colleagues to adjust their practices, even in the context of prospective trial results. However, clinical practice should be guided by robust evidence rather than personal experience. We, therefore, encourage Drs. Leslie and Stranix to collect prospective data and publish their results for the benefit of patients across the UK where diamorphine is used commonly. Indeed, as a drug that is used commonly in the UK, it is disappointing that only 12 trials have been published over the past 35 years. We encourage clinicians and researchers to conduct dose–response studies urgently to better define the efficacy and safety profiles of intrathecal diamorphine.