We congratulate Urmale Kusse et al. [1] on their recent study that found that the analgesic effect following erector spinae plane block was superior to that of the rectus sheath block in midline abdominal surgeries. However, there are three points that I would like to discuss further with the authors.

First, three primary endpoints were established but it was not clearly stated whether their conclusion that erector spinae plane block is superior to the rectus sheath block requires the fulfilment of all three endpoints or just one of them. If only one endpoint is sufficient, the issue of inflated type 1 errors must be considered. Furthermore, the sample size calculation should have been conducted separately for the three endpoints, selecting the largest sample size for the study. This approach would reduce the incidence of type 1 and type 2 errors, thereby yielding more reliable results.

Second, the study did not evaluate standardised endpoints such as the time of first activity, gastrointestinal recovery, duration of hospital stay and patient satisfaction [2]. In this context, it is difficult for readers to determine whether the improvement in early postoperative pain control associated with the erector spinae plane block is clinically significant.

Third, the authors suggest broad applicability of their findings to middle- and low-income countries. However, as a single-centre trial with a small sample size, the generalisability of this study is limited, making the conclusion potentially overstated.

我们祝贺 Urmale Kusse 等人 [1] 最近的研究发现，在腹部中线手术中，竖脊肌平面阻滞后的镇痛效果优于直肌鞘阻滞。但是，我想与作者进一步讨论三点。

首先，确定了三个主要终点，但没有明确说明他们关于竖脊肌平面阻滞优于直肌鞘阻滞的结论是否需要满足所有三个终点还是仅满足其中一个终点。如果只有一个端点就足够了，则必须考虑膨胀的 1 类错误问题。此外，应针对三个终点分别进行样本量计算，为研究选择最大的样本量。这种方法将减少 1 类和 2 类错误的发生率，从而产生更可靠的结果。

其次，该研究没有评估标准化终点，例如首次活动时间、胃肠道恢复、住院时间和患者满意度 [2]。在这种情况下，读者很难确定与竖脊肌平面阻滞相关的术后早期疼痛控制的改善是否具有临床意义。

第三，作者认为他们的研究结果广泛适用于中等收入和低收入国家。然而，作为一项样本量小的单中心试验，这项研究的普遍性是有限的，这使得结论可能被夸大了。