We read with interest this prospective randomized clinical trial on the methods of pain relief following percutaneous nephrolithotomy by Gyawali et al.[1] We feel the following needs clarification. In the methodology, the author mentioned that they conducted a double-blind study, but this is not possible as the surgeon instilled the bupivacaine, thus he knows the intervention, i.e., whether an intercostal nerve block (ICNB) or peritract infiltration was given.[2] Therefore, it is a single-blind study. Furthermore, it is mentioned that the patients were randomized using the sealed envelope method. However, the type of randomization performed and the method used to generate the random allocation sequence are not mentioned[3] Whether a test for normality was used or not and if used which test was used is also not mentioned. Mean scores were directly used for quantitative variables considering the sample as normally distributed. Furthermore, while the authors mention that the sample size was calculated based on a published study but the method and parameters used (i.e., alpha error, beta error, anticipated mean, and anticipated decrease or increase in the pain score following the intervention) are not mentioned.[4] Patients older than 16 years of age were included in the study after obtaining informed consent from them. However, at this age, patients are legally not suitable to give consent and it is not mentioned whether the consent was taken from their parents. In the exclusion criteria – "<16 years patients were excluded" need not be mentioned as the "patients >16 years are taken" in the study has already been mentioned in the inclusion criteria In this study, for ICNB, the anesthetic agent was instilled between the innermost intercostal muscle and the pleura, but for ICNB, the local anesthetic agent is instilled between the internal and innermost intercostal muscle layers as the neurovascular bundle is present in this plane.[5] We would also like to highlight a few points for consideration to add more value to the study. In how many patients was the nephrostomy tube placed? As it will affect the pain score. And, why was the percutaneous nephrostomy tube kept for a mean duration of 5 days in both the groups? Was there any specific reason? Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
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