Objective To assess the effectiveness of intrathecal fentanyl in the relief of post operative pain in patients undergoing lumbar decompression or fusion.

Method 60 patients undergoing lumbar spinal surgery were prospectively recruited. All patients received our standard analgesic regime with PCA via a syringe driver. They were also randomised to receive either 15 micrograms of fentanyl intrathecally, or nothing. The fentanyl was administered by the operating surgeon (GM) under direct vision one or two levels above the site of the operation at the end of the procedure. VAS pain scores were taken at 2, 4, 24 and 48 hours post operatively independently. The total dose of morphine required was recorded.

Results The patients randomised to receive fentanyl showed a decrease in their mean VAS scores as well as a 40% reduction in the total morphine dose delivered. There was no increased incidence of side effects in the group receiving fentanyl. No patients suffered respiratory compromise requiring treatment. All patients left recovery after 2 hours to be nursed on an open ward.

Conclusion Intrathecal fentanyl is effective at reducing mean pain VAS scores and morphine use via a PCA after lumbar spinal surgery. We would support its use over intrathecal morphine because of the reduced incidence of respiratory complications and the ability to nurse patients on the open ward.

Objective A prospective longitudinal study with a mean 22 month follow up (range 6–36 months) to assess the outcome of patients with chronic discogenic lumbar back pain who underwent intradiscal electrothermal therapy (IDET).

Method Patients with a discogenic origin of their back pain confirmed by diagnostic imaging and discography and who underwent IDET were included in the study. Discographic reproduction of symptoms with subsequent abolition with local anaesthetic led to inclusion in the study regardless of discogram volume. Outcome was assessed using VAS pain scores, Oswestry Disability Index (ODI) scores, employment status, subjective outcome and pain diagrams.

Results 68 patients were treated with IDET. 51 patients were successfully followed up for a minimum of one year, of whom 31 had at least 2 year follow up. These patients were divided into two groups. Group 1 consisted of 29 patients aged less than 40 with single level disease, no facet joint arthritis, a low volume positive discogram and an organic pain diagram. Their mean VAS scores decreased from 7.52 to 3.84 (p< 0.001). 70% reported a good or excellent outcome with only 30% fair or poor. Group 2 included the remaining 22 patients. Their mean VAS decreased from 7.41 to 6.13 and only 32% reported a good or excellent outcome with 68% fair or poor.

Conclusion We conclude that with very strict selection criteria, IDET can have a successful outcome.