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

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    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
    Issue Date
    2012-02-03T15:04:15Z
    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
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    Citation
    Eur J Anaesthesiol. 2010 Aug;27(8):696-701.
    Journal
    European journal of anaesthesiology
    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
    ISSN
    1365-2346 (Electronic)
    0265-0215 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1097/EJA.0b013e32833b46dc
    Scopus Count
    Collections
    Cork University Hospital

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