Preoperative Norepinephrine Levels in Cerebrospinal Fluid and Plasma of Pediatric Patients Predict Postoperative Pain Intensity after Spinal Fusion Surgery
Bibliographic record
Abstract
Introduction The purpose of the present study was to investigate if preoperative concentrations of monoamine neurotransmitters that are known to be involved in descending pain modulation are associated with perioperative pain intensity in a pediatric cohort of patients with idiopathic scoliosis scheduled for elective spinal fusion surgery. Material and Methods Patients scheduled to undergo spinal surgery for Adolescent Idiopathic Scoliosis (AIS) between the ages of 12 and 18 years were recruited from the outpatient clinic of the Shriners Hospital for Children ( n = 50). Plasmatic and cerebrospinal fluid concentrations of epinephrine (EPI), norepinephrine (NE), and their respective metabolite metanephrine (ME) and normetanephrine (NME), were assessed. Five mL of blood were collected for study analysis in an EDTA-coated collection tube after the anesthesia induction. Prior to the intratechal epimorphine injection, 2 mL of cerebrospinal fluid was collected in a low binding protein tube. Monoamine neurotransmitters were derivatized by reductive diethylation analyzed by liquid chromatography coupled with tandem mass spectrometry on TripleTOF 5600 mass spectrometer. At all time points throughout the study (preoperative, first postoperative 24 hours = postoperative day 1 (POD1), second 24 hours = postoperative day 2 (POD2) and postoperative 6 weeks follow-up visit), pain intensity was rated with the use of the Faces Pain Scale-Revised (FPS-R). Linear regressions were performed to assess the predictive role of catecholamine levels for postoperative pain. The Mann-Whitney-U test was used to assess differences in baseline characteristics between patients reporting presence of pain and pain-free patients as well as for all other comparisons other than correlations. Results Our results demonstrate that patients reporting persistent postsurgical pain 6 weeks after surgery have greater preoperative peripheral and/or central norepinephrine (NE) and normetanephrine levels when compared with patients reporting no pain at follow-up. Likewise, in the acute postoperative period, patients reporting moderate-to-severe pain intensity had higher preoperative central NE levels. Conclusion These results support the evidence for a potential role of catecholamine levels in predicting postoperative pain intensity and sympathetically maintained pain, which could place pediatric patients at risk for the development of chronic postsurgical pain. Incidence and severity of persistent postoperative pain may be reduced by specific NE preoperative interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".