Meier et al. contend that our trial poorly tested the effect of multimodal analgesia because we did not control intraoperative local anesthetic use or postoperative analgesia. Epidural analgesia is rarely used for spine surgery in our setting. As presented in Table 1, fewer than 1% of our patients had epidural analgesia. Furthermore, local wound infiltration was used only in one quarter of the patients in each group: analgesic pathway 39 (26%) versus 32 (22%) in placebo. In a robust double-blind randomized trial (n = 299), there is no reason to expect substantive differences between treatment and placebo groups.

Meier et al. write that “measuring the Quality of Recovery score 3 days after surgery, as well as other postsurgical pain measures, is confounded when both the experimental and control groups received multimodal analgesics during and...

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