Hickey, OT,Burke, SM,Hafeez, P,Mudrakouski, AL,Hayes, ID,Keohane, C,Butler, MA,Shorten, GD

2010

January

European Journal of Anaesthesiology

Determinants of outcome for patients undergoing lumbar discectomy: a pilot study

Validated

()

back lower back pain nitric oxide sensory thresholds PHOSPHOLIPASE A(2) ACTIVITY NITRIC-OXIDE METABOLITES SENSORY NERVE-FIBERS INTERVERTEBRAL DISC BACK-PAIN MATRIX METALLOPROTEINASES DIFFERENT POPULATIONS NEUROPATHIC PAIN SURGERY PREDICTORS

27

696

701

Background and objective One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus.Methods A prospective observational pilot study of patients (n = 39) was performed. Quantitative sensory testing, visual analogue scales for anxiety and pain, the Hospital Anxiety and Depression (HADS) Scale and the McGill Pain Questionnaire were completed, and serum nitric oxide metabolites were measured perioperatively. Excised disc tissue was examined histologically, and immunohistochemistry for phospholipase A2 was performed.Results Ten patients (26%) had an unsatisfactory outcome. Those with a satisfactory outcome had greater preoperative pain perception thresholds over the affected dermatome, which decreased by 2 months postoperatively. These patients also demonstrated a decrease in nitric oxide metabolites from preoperatively to 18 h postoperatively. Greater preoperative HADS scores, and greater pain intensity 4 h and 24 h postoperatively were associated with an unsatisfactory outcome.Conclusion Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study. Eur J Anaesthesiol 2010; 27:696-701

DOI 10.1097/EJA.0b013e32833b46dc