Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: A systematic review and meta-analysis

Zi-Fang Zhao; Lei Du; Dong-Xin Wang

doi:10.1371/journal.pone.0240561

Peer Review History

Original SubmissionJuly 26, 2020
19 Aug 2020 Decision Letter - Laura Pasin, Editor PONE-D-20-23215 Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: a systematic review and meta-analysis PLOS ONE Dear Dr. Dong-Xin Wang , Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 18/09/20. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Laura Pasin Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear editor, Dear authors, I read with pleasure the paper entitled "Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: a systematic review and meta-analysis" In their paper Zi-Fang Zhao and colleagues investigated the the benefit and effectiveness of dexmedetomidine as adjuvants to local anesthetics for femoral nerve block. Below I am reporting some concerns: Was this meta-analysis registered prospectically? Please provide registration number. Search strategy Please present the search strategy for each database as supplementary material "Subsequently, we identified the possibly included trials by carefully reading the full text". Do you mean reading the references in the full text? Inclusion and exclusion criteria: Please present inclusion and exclusion criteria as PICOS. Bias You used Cochrane’s risk-of-bias tool, however it is an out of date tool, please use ROB2 Do you contact authors for missing data? If not please state that in method section Results One study was excluded because the effects could not be estimated with RevMan software. What means? Please use GRADE to assess quality of the evidence Please provide a table with sensitivity analysis Discussion "increases hypotension and lowers blood pressure when compared with sham control." aren't they synonim synonyms? "However, it should eb noted that" typo Reviewer #2: The authors present a meta-analysis analyzing the effects related to the use of Dex during FNB. Peripheral nerve blocks and opioid-sparing techniques are topics interesting and under scientific debate. The limits of the analysis are well described in the discussion. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Alessandro De Cassai Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0240561.r001
Revision 1
15 Sep 2020 Author Response Reviewer #1: 1. Was this meta-analysis registered prospectically? Please provide registration number. Response: Thanks for your sincere comment. We failed to register this meta-analysis prospectively and this was a limit. 2. Please present the search strategy for each database as supplementary material. Response: Thanks for pointing out this. We have added the search strategies for all database and submitted in “Revised Supplementary 2”. 3. "Subsequently, we identified the possibly included trials by carefully reading the full text". Do you mean reading the references in the full text? Response: Thanks for your careful reading and prudent attitude. We revised the sentence as below in order to clarify the procedure: “Subsequently, the identified articles were screened by reading the title and retrieved abstracts. Full text of selected articles was carefully read for possible inclusion. We also checked the reference lists of selected articles to avoid the omission of any eligible trials (page 4, line 14)”. 4. Please present inclusion and exclusion criteria as PICOS. Response: As suggested, we have revised the inclusion and exclusion criteria accordingly. 5. You used Cochrane’s risk-of-bias tool, however it is an out of date tool, please use ROB2. Response: Thanks for your advice. We have provided a “Revised Figure 2” which presents the details of risk of bias by using RevMan software. 6. Do you contact authors for missing data? If not please state that in method section. Response: Thanks for pointing out this. We clarified this in the revised manuscript: “For studies that reported missing or insufficient data, we attempted to contact authors to acquire data. When feasible, data were extrapolated from figures or tables (page 5, line 17)”. 7. One study was excluded because the effects could not be estimated with RevMan software. What means? Response: Thanks for careful reading. We revised the sentence in order to clarify the meaning: “One study was excluded because of limited data and the effects could not be estimated with RevMan software (page 11, line 9)”. 8. Please use GRADE to assess quality of the evidence. Response: Many thanks for your suggestion. We added a paragraph (page 12, line 4) in the main text and Table 2 (page 13) to describe the GRADE evaluations in the revised manuscript. 9. Please provide a table with sensitivity analysis. Response: Thanks for your kind suggestion. In the present meta-analysis, statistical analysis was performed with RevMan software. Sensitivity analysis was performed by excluding the study with a potentially high risk of bias when doing analysis with the software; no notable changes were found in all three timepoints after excluding any of these studies. The process cannot be exported as images or tables. We reported these findings in the Result section as below. In the “Pain scores in resting state” section, “Sensitivity analysis was conducted to detect the origin of heterogeneity, but no notable changes were found in all three timepoints after excluding any of these studies (page 9, line 23).” In the “Duration of analgesic effects” section, “Sensitivity analysis was performed, but the recalculated MD and heterogeneity after excluding any of the trials showed no significant changes (page 11, line 2).” In the “Pain scores in active state” section, we reported that “The effect of DEX in reducing active pain score was not altered after divided into single-shot FNB [19, 21, 23] and continuous FNB subgroups [25-27] (page 10, line 14).” 10. "increases hypotension and lowers blood pressure when compared with sham control." aren't they synonim synonyms? Response: Thanks for pointing out this. We have corrected the sentence: “Pooled data in the current review also showed that use of DEX for FNB increases hypotension when compared with sham control (page 17, line 5)”. 11. "However, it should eb noted that" typo. Response: We have made correction (page 17, line 7). Reviewer #2: 1. The authors present a meta-analysis analyzing the effects related to the use of Dex during FNB. Peripheral nerve blocks and opioid-sparing techniques are topics interesting and under scientific debate. The limits of the analysis are well described in the discussion. Response: Thank you very much. https://doi.org/10.1371/journal.pone.0240561.r002
29 Sep 2020 Decision Letter - Laura Pasin, Editor Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: a systematic review and meta-analysis PONE-D-20-23215R1 Dear Dr. Wang, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Laura Pasin Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0240561.r003
Formally Accepted
5 Oct 2020 Acceptance Letter - Laura Pasin, Editor PONE-D-20-23215R1 Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: a systematic review and meta-analysis Dear Dr. Wang: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Laura Pasin Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0240561.r004

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