Preoperative Norepinephrine Levels in Cerebrospinal Fluid and Plasma Correlate With Pain Intensity After Pediatric Spine Surgery

Spine Deform. 2017 Sep;5(5):325-333. doi: 10.1016/j.jspd.2017.03.012.


Purpose: Catecholamines were found to be involved in descending pain modulation and associated with perioperative pain. The purpose of the present study was to investigate the relationship between preoperative concentrations of catecholamines and postoperative pain intensity of pediatric patients.

Methods: Fifty adolescents with idiopathic scoliosis scheduled for elective spinal fusion surgery were enrolled in this prospective cohort study. Preoperative plasma and cerebrospinal fluid (CSF) samples were collected and analyzed by mass spectrometry. Pain intensity was assessed during the acute postoperative period and in the intermediate period.

Results: Preoperative plasma concentrations of norepinephrine (NE) and normetanephrine (NME), as well as the CSF concentration of NE, were significantly correlated with the presence of pain six weeks after surgery (r = 0.48, 0.50, and 0.50, respectively; p < .002). We also found that preoperative NE levels in CSF were significantly higher in patients reporting moderate to severe pain intensity than in patients with mild pain during the first day following surgery (0.268 ± 0.29 ng/mL vs. 0.121 ± 0.074 ng/mL, p = .01), as well as between patients reporting pain and painless patients at 6 weeks postsurgery (0.274 ± 0.282 ng/mL vs. 0.103 ± 0.046 ng/mL respectively, U = 69.5, p = .002).

Conclusions: These results support the potential role of catecholamine levels in predicting postoperative pain intensity.

Keywords: Adolescent idiopathic scoliosis; Catecholamines; Cerebrospinal fluid; Perioperative pain; Plasma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • Biomarkers / cerebrospinal fluid
  • Child
  • Female
  • Humans
  • Male
  • Norepinephrine / blood*
  • Norepinephrine / cerebrospinal fluid*
  • Normetanephrine / blood
  • Pain Measurement
  • Pain, Postoperative / blood
  • Pain, Postoperative / cerebrospinal fluid
  • Pain, Postoperative / etiology*
  • Postoperative Period
  • Preoperative Period
  • Prospective Studies
  • Risk Factors
  • Scoliosis / blood*
  • Scoliosis / cerebrospinal fluid*
  • Scoliosis / surgery
  • Spinal Fusion / adverse effects*


  • Biomarkers
  • Normetanephrine
  • Norepinephrine