We read with great interest the study by Dr Mostafa and colleagues comparing dexmedetomidine and clonidine for ultrasound-guided transversus abdominis plane (TAP) block in paediatric laparoscopic orchiopexy in a well-designed, multi-arm randomized controlled trial. The authors concluded that clonidine may be substituted for dexmedetomidine with a local anaesthetic during TAP block for paediatric laparoscopy because of easy availability and lower cost (Mostafa et al., 2021). At the outset, the authors should be congratulated for conducting a well-designed study and examining a very important topic in peri-operative medicine. Nevertheless, we have several suggestions and queries that we would like to communicate with the authors.

First of all, whether the effects of dexmedetomidine or clonidine are related to systemic absorption or purely local effects was not fully elucidated in the article. Further studies are needed to determine the plasma levels of dexmedetomidine and clonidine. Secondly, the gender ratio in each group was not clarified in the demographic characteristics, making it difficult to determine whether the study had gender biased. Thirdly, it was difficult for the authors to assess the success rate of TAP block due to general anaesthesia. So would it be better to use spinal anaesthesia in further studies? Finally, the authors did not conduct a dose–response study to determine whether different doses of dexmedetomidine or clonidine led to similar results. Further studies are needed to confirm the optimal dose of both in TAP block.

Overall, Mostafa et al. analysed a valuable issue and made a valuable attempt with TAP block in paediatric laparoscopic orchiopexy, but whether the conclusion is solid or not needs further consideration.

我们非常感兴趣地阅读了 Mostafa 博士及其同事在一项精心设计的多臂随机对照试验中比较右美托咪定和可乐定用于小儿腹腔镜睾丸固定术超声引导下腹横肌平面 (TAP) 阻滞的研究。作者得出的结论是，在儿科腹腔镜检查的 TAP 阻滞期间，可乐定可以用局部麻醉剂代替右美托咪定，因为它易于获得且成本较低（Mostafa 等人，  2021 年）。首先，应该祝贺作者进行了精心设计的研究，并检查了围手术期医学中一个非常重要的主题。尽管如此，我们还是有一些建议和疑问要与作者交流。

首先，文章没有充分阐明右美托咪定或可乐定的作用是与全身吸收有关还是纯粹的局部作用。需要进一步研究以确定右美托咪定和可乐定的血浆水平。其次，各组的性别比例在人口学特征上没有明确，难以判断研究是否存在性别偏倚。第三，由于全身麻醉，作者难以评估 TAP 阻滞的成功率。那么在进一步的研究中使用脊髓麻醉会更好吗？最后，作者没有进行剂量反应研究来确定不同剂量的右美托咪定或可乐定是否会导致相似的结果。需要进一步的研究来确认两者在 TAP 阻滞中的最佳剂量。

总的来说，Mostafa 等人。分析了一个有价值的问题，并在小儿腹腔镜睾丸固定术中使用TAP阻滞进行了有价值的尝试，但结论是否可靠还需要进一步考虑。