Re: “Continuous wound infusion as a valid alternative to tap block for postoperative analgesia after abdominal hysterectomy: A randomized controlled trial” by Costa et al.[]

Dear Editor, We read with great interest the recent article by Costa et al.[1] (Saudi J Anaesth 2025;19:227-34), which presents a prospective randomized controlled trial comparing continuous wound infusion (CWI) and transversus abdominis plane (TAP) block in patients undergoing total abdominal hysterectomy (TAH). The authors are to be commended for their well-designed investigation and their efforts to address a long-standing clinical question in postoperative analgesia. We particularly appreciate the study’s novel approach in utilizing a preperitoneal catheter placement for CWI, which likely contributed to the improved pain scores. This precise anatomical strategy aligns with recent insights into peritoneal nociceptor-mediated pain and may explain the superior analgesia seen in the CWI group.[2] Furthermore, the decision to perform TAP block postoperatively helps reduce potential confounding, strengthening the internal validity of the findings.[3] Nevertheless, we would like to raise a few considerations: Analgesic regimen adherence: The absence of patient-controlled analgesia (PCA) and reliance on subjective nurse-administered opioid dosing may have introduced heterogeneity in pain control, particularly in the TAP group, including PCA or standardized demand-based opioid rescue protocols might enhance the comparability between arms. Small sample size and confidence intervals: While statistical significance was achieved in several outcomes, the study’s limited sample size restricts the generalizability. Reporting confidence intervals alongside median numerical rating scale (NRS) values could provide a clearer picture of the clinical relevance and variability of the effect sizes. Potential underestimation of dynamic pain: Pain during movement is critical for postoperative recovery. While dynamic NRS scores were included, a more detailed analysis (e.g., correlation with ambulation milestones) may help determine the functional benefit of CWI more clearly. In conclusion, this study adds valuable evidence to support CWI as a feasible and possibly superior alternative to TAP block for open hysterectomy. We encourage future multicenter trials with larger cohorts and standardized analgesic protocols to confirm these promising results. Sincerely, Shaobo Zhu, MD Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.