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Single Dose Preemptive Amitriptyline Reduces Postoperative Neuropathic Pain After Lumbar Laminectomy and Discectomy: A Randomized Placebo-controlled Clinical Trial

Vahedi, Payman MD*; Salehpour, Firooz MD*; Aghamohammadi, Dawood MD; Shimia, Mohammad MD; Lotfinia, Iraj MD; Mohajernezhadfard, Zahra MD§; Vahedi, Yazdan MD

doi: 10.1097/WNQ.0b013e3181ebce15
Original Articles
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Background Ongoing neuropathic pain is a common problem in patients undergoing lumbar discectomy. Central sensitization is believed to be the main cause of maintained neuropathic pain after discectomies. Tricyclic antidepressants are known as the drug of choice for neuropathies; however their acute role is a matter of controversy. The aim of this study is to assess the acute role of amitriptyline to reduce postoperative pain and opioid consumption in single level lumbar discectomies.

Methods Over 1 year, patients with a decision for single level lumbar laminectomy and discectomy were randomly assigned into groups A and B, each received similar capsules containing amitriptyline or matching placebo 2 hours before surgery. Same anesthetic protocol was performed. Only patients with postoperative leg pain remained in the study. Visual analog scale and morphine consumption were recorded at 6 hours intervals up to 24 hours. The results were analyzed by SPSS V.13 and χ2 and t test were used as the statistical tests. Finally, the groups were revealed: “A” was amitriptyline and “B” was the placebo group.

Results Pain was significantly reduced in each group at each time intervals (P<0.001). The amitriptyline group had a significantly lower pain score by the end of 24 hours (P=0.047), whereas morphine consumption was not different statistically.

Conclusions Preemptive amitriptyline is effective to reduce remained neuropathic pain after lumbar discectomies. The treatment of neuropathic pain should be considered before the surgery.

*Department of Neurosurgery, Imam Hospital

Department of Anesthesia and Critical Care

Department of Neurosurgery, Shohada Hospital, Tabriz

§Department of Ophthalmology, Farabi Hospital, Tehran University of Medical Sciences, Tehran

Department of Public Health, Mashad University of Medical Sciences, Mashad, Iran

Reprints: Payman Vahedi, MD, Department of Neurosurgery, Imam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran (e-mail: payman.vahedi@gmail.com).

This study has been conducted as a medical dissertation for the specialty degree (No: 87/3-8/11) by the first author, the research protocol was approved by the research vice chancellor of Tabriz University of Medical Sciences and the ethics committee of TUMS (registered number: 883). The trial has been registered at http://www.clinicaltrials.gov (registered number: NCD01014520). Informed consent was taken from all participants.

All the authors have significant contribution in the study. We also confirm that the study is neither under review or publication by any other journal.

© 2010 Lippincott Williams & Wilkins, Inc.