A randomized trial of local anaesthetic in treatment of quinsy

Sir, The article by Tandon et al.1 was a commendable attempt at performing a randomized trial – of which, as we all know, there is a paucity in surgical literature. May I suggest however, that they missed a perfect opportunity to perform a double blind and placebo-controlled trial. Unfortunately, the combination of an unblinded intervention and a subjective patient assessment of efficacy mean that the results are likely to be biased. If, following local ethics committee approval, they had sought the help of a hospital pharmacist in making up syringes with saline or local anaesthetic, the study would not only be double-blind and placebo-controlled, but the randomization list could be concealed from the investigators, therefore fulfilling a further important condition.2 Randomization is an essential technique for reducing selection bias in studies, but as in this paper, the mere act of performing randomization is not enough. Investigators should be highly critical of the process if systematic errors are to be avoided and reporting should be explicit, preferably following the international consort guidelines (http://www.consort-statement.org).