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

Hdl Handle:
http://hdl.handle.net/10147/208817
Title:
Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.
Authors:
Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvais; Mudrakouski, Alexander L; Hayes, Ivan D; Keohane, Catherine; Butler, Mark A; Shorten, George D
Affiliation:
Department of Anaesthesia, Cork University Hospital, Cork City, Ireland., oonaghhickey@yahoo.co.uk
Citation:
Eur J Anaesthesiol. 2010 Aug;27(8):696-701.
Journal:
European journal of anaesthesiology
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208817
DOI:
10.1097/EJA.0b013e32833b46dc
PubMed ID:
20520554
Abstract:
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.
Language:
eng
MeSH:
Adult; *Diskectomy/adverse effects; Double-Blind Method; Female; Humans; Low Back Pain/psychology/surgery; Lumbar Vertebrae/pathology/*surgery; Male; Middle Aged; Pain Measurement/methods/*psychology; Pain Threshold/*psychology; Pain, Postoperative/prevention & control/*psychology; Pilot Projects; Preoperative Care/methods/*psychology; Prospective Studies; Treatment Outcome; Young Adult
ISSN:
1365-2346 (Electronic); 0265-0215 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorHickey, Oonagh Ten_GB
dc.contributor.authorBurke, Siun Men_GB
dc.contributor.authorHafeez, Parvaisen_GB
dc.contributor.authorMudrakouski, Alexander Len_GB
dc.contributor.authorHayes, Ivan Den_GB
dc.contributor.authorKeohane, Catherineen_GB
dc.contributor.authorButler, Mark Aen_GB
dc.contributor.authorShorten, George Den_GB
dc.date.accessioned2012-02-03T15:04:15Z-
dc.date.available2012-02-03T15:04:15Z-
dc.date.issued2012-02-03T15:04:15Z-
dc.identifier.citationEur J Anaesthesiol. 2010 Aug;27(8):696-701.en_GB
dc.identifier.issn1365-2346 (Electronic)en_GB
dc.identifier.issn0265-0215 (Linking)en_GB
dc.identifier.pmid20520554en_GB
dc.identifier.doi10.1097/EJA.0b013e32833b46dcen_GB
dc.identifier.urihttp://hdl.handle.net/10147/208817-
dc.description.abstractBACKGROUND 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.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.mesh*Diskectomy/adverse effectsen_GB
dc.subject.meshDouble-Blind Methoden_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLow Back Pain/psychology/surgeryen_GB
dc.subject.meshLumbar Vertebrae/pathology/*surgeryen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPain Measurement/methods/*psychologyen_GB
dc.subject.meshPain Threshold/*psychologyen_GB
dc.subject.meshPain, Postoperative/prevention & control/*psychologyen_GB
dc.subject.meshPilot Projectsen_GB
dc.subject.meshPreoperative Care/methods/*psychologyen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshYoung Adulten_GB
dc.titleDeterminants of outcome for patients undergoing lumbar discectomy: a pilot study.en_GB
dc.contributor.departmentDepartment of Anaesthesia, Cork University Hospital, Cork City, Ireland., oonaghhickey@yahoo.co.uken_GB
dc.identifier.journalEuropean journal of anaesthesiologyen_GB
dc.description.provinceMunster-

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