References
Postoperative pain, hallucinations, tachycardia, pain
SAID

1. The study design: - Random grouping is unequal: The proportion of patients undergoing total thyroidectomy or partial thyroidectomy is much different between the two groups. Different types of surgery result in different level of pain. It make great influence on research results. - The post-operative pain relief design is not appropriate. When VAS score > 30, author used Nefopam. Nefopam is a strong pain relief but it causes a tachycardia so it needs to be infused slowly, with an infusion time is 30 minutes or more. So, this medicine is not suitable for pain relief. An NSAID group such as Ketorolac can be used. Furthermore, when using Nefopam, the dose must also be controlled, not exceeding 120mg per day. So if the patient has already taken 120 mg and still has pain, what is the next treatment? - Patients were assessed for pain both at rest or swallowing, but when swallowing, the VAS score was very high in the group not using Ketamine. This is not clinically appropriate in the first 120 minutes, because when author knew the patients were in pain, author still force the patient to perform swallowing for research without giving any additional pain relief. It can be said that author did not respect research ethics. 2. Data results - It need to add a table of results about side effects of pain relief methods, especially hallucinations when using Ketamine. The research object and method section should clearly state: Criteria for diagnosing hallucinations, prevention and treatment. ​3. Discussion and conclusion  ​​​​​​- Discussion does not focus on the question research or the research results.Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?PartlyAre all the source data underlying the results available to ensure full reproducibility?PartlyIs the study design appropriate and is the work technically sound?PartlyAre the conclusions drawn adequately supported by the results?YesAre sufficient details of methods and analysis provided to allow replication by others?PartlyReviewer Expertise:AnesthesiologistI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
The authors have addressed the requested revisions.Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?YesAre all the source data underlying the results available to ensure full reproducibility?YesIs the study design appropriate and is the work technically sound?YesAre the conclusions drawn adequately supported by the results?YesAre sufficient details of methods and analysis provided to allow replication by others?YesReviewer Expertise:Regional anesthesia, Anesthesiology, critical care, cardiac anesthesia, artificial intelligenceWe confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Postoperative opioid requirements were assessed only in the PACU. Postoperative pain is your primary outcome. Please rephrase your title.Difficult airways should be considered as an  exclusion criteria because you had assessed VAS during swallowing.Please precisely include which ketamine concentration was used.Baseline characteristics should be comparable between the two groups. Please verify your data (age, performed surgery).You have many VAS assessments exceeding 3/10. What was your rescue analgesia?The choice of ketamine dosage should be discussed."However, the use of ropivacaine was not associated with an analgesic effect.
VAS was considered as a limitation while it is a validated tool.Please put “to reduce” instead of “to reducing”.Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?PartlyAre all the source data underlying the results available to ensure full reproducibility?PartlyIs the study design appropriate and is the work technically sound?YesAre the conclusions drawn adequately supported by the results?YesAre sufficient details of methods and analysis provided to allow replication by others?YesReviewer Expertise:Anesthesia and intensive careI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.