Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc operations. This study aims to investigate the effects of methylene blue (MB) on preventing postoperative low-back pain (LBP) with or without radicular pain and improving the quality of life (QOL) in patients undergoing lumbar open discectomy.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This is a prospective, randomized, triple-blind, placebo-controlled clinical trial, which was conducted at Shiraz University of Medical Sciences between July 2011 to January 2012. Of a total of 130 patients, 115 were eligible for participation; 56 received 1 ml of MB solution at a concentration of 0.5% (MB group) and 59 received an equivalent volume of normal saline (control group). Primary outcomes were the control of LBP with or without radicular pain, which was evaluated preoperatively and at 24 hours and 3 months after surgery with the use of a visual analog scale (VAS), and the improvement of QOL, which was assessed preoperatively and 3 months postoperatively by means of the Persian translation of the Oswestry Disability Index questionnaire.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The mean VAS scores for LBP were significantly lower in the MB group compared with the control group at 24 hours (1.25 ± 0.97 vs 2.80 ± 0.69, p &lt; 0.001) and 3 months (1.02 ± 1.29 vs 2.07 ± 1.10, p = 0.019) after treatment. The mean radicular pain scores decreased significantly in the 2 groups at 24 hours after surgery, but the mean radicular pain score was significantly lower in the MB-treated patients than the control group. However, the difference between radicular pain scores in the MB group (1 ± 1.1) and the control group (1.2 ± 1) was not statistically significant (p = 0.64). The reduction in LBP was greater in the MB group than the control group (8.11 ± 1.74 vs 6.07 ± 1.52, p = 0.023, CI 95% −1.37 to −0.10). The functional QOL improved significantly 3 months after the operation in both groups (p &lt; 0.001). Moderate disability occurred more frequently in the control group than in the MB group (14.5% vs 7.7%, p = 0.004). No toxicity, adverse effects, or complications were found in the group of patients treated with MB injection.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>A single dose of MB (1 ml 0.5%) for coating the dura and surrounding tissues (facet and muscle) shows promising results in terms of safety, reduction of postoperative pain, and functional outcome compared with placebo.</jats:p></jats:sec>

To what extent topical application of cova&#8482; and tisseel® cause spinal peridural fibrosis? comparison with adcon® gel: an experimental study in rat model.

“…Many factors play a role in amount of peridural scar formation such as postoperative hematoma, postoperative infection and surgical techniques. Improved minimally invasive surgery techniques, many agents and mechanical barriers have been used to accomplish this bothering problem (5,6,12,14,15,17,19,26,(29)(30)(31)33).…”

“…There was no grade 0 in the laminectomy group. (4,6,8,11,12,14,20,(29)(30)(31). Actually, PF is a healing process after surgery and it occurs to some degree in response to Samples of histopathological sections for grade 1 (HE stain sample of grade 1 fibrosis) and grade 2 (MT stain sample of grade 2 fibrosis) are demonstrated in Figure 1 and Figure 2.…”

Intradiscal Methylene Blue Injection for Discogenic Low Back Pain: A Meta‐Analysis

“…The following data were extracted: author, year published, age, sample size, pain duration, time of preoperation, and visual analog scale (VAS) or numeric rating scale (NRS) scores and ODI scores of preoperation at follow‐up times of 3, 6, and 12 months. For those studies that met the inclusion criteria but data was not readily available in the article, the authors (LZ.L., SD.Y.) tried to contact the researchers via e‐mail for raw data.…”

Nitric Oxide and Related Aspects Underlying Angina

“…Regarded as a therapy, since chronic pain patients showed a significant increase in NO plasma levels in comparison with healthy individuals [83], methylene blue (MB) is the most studied drug affecting NO mechanisms [64-73, 82]. MB directly inhibits constitutive and inducible NOS [65] through cGMP accumulation avoidance by GC enzyme blockage [65, 66].…”