Document Detail


Effect of pre- or post-traumatically applied i.v. lidocaine on primary and secondary hyperalgesia after experimental heat trauma in humans.
MedLine Citation:
PMID:  11068117     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hyperalgesia on intradermal capsaicin application can be attenuated by systemic application of local anesthetics. We tested whether low doses of local anesthetics applied pre- or post-traumatically can reduce heat trauma-induced primary and secondary hyperalgesia in humans. Six healthy volunteers consented to the randomized, double-blind, and cross-over designed study. In each subject, a first-degree burn injury was induced three times (corresponding to a pre-traumatic, post-traumatic and control group) at an interval of at least 3 weeks. Heat was applied by a computer-controlled Peltier thermode (47 degrees C, 5 min). In the pre-traumatic group, lidocaine infusion was commenced 30 min prior to heat trauma, and in the post-traumatic group immediately after heat trauma for a total infusion time of 60 min each. Volunteers rated pain on a visual analogue scale (VAS) between threshold and tolerance maximum (0-100% VAS). Primary hyperalgesia was quantified by determining mechanical (von Frey hairs) and thermal (Peltier thermode) pain thresholds. Secondary hyperalgesia was quantified by determining the area in which normally unpleasant von Frey hairs evoked pain or tenderness. Baseline thermal and mechanical pain thresholds did not differ between groups. Heat application always resulted in a first-degree burn injury including both primary and secondary hyperalgesia. The former remained by and large stable for about 4 h whereas the latter continuously increased within the first 2 h. Lidocaine did not affect primary hyperalgesia, irrespective of pre- or post-traumatic application, but substantially reduced the development of secondary hyperalgesia on pre-traumatic, and for tendency on post-traumatic infusion (treatment groups did not differ significantly). Burn injury-induced erythema was smallest in the pre-traumatic group and largest in the control group; however, the level of significance was not reached. Plasma concentrations of lidocaine were always higher than 1.5 microg/ml 30 min after bolus application of lidocaine and reached a peak of 2-3 microg/ml after about 1 h. Thus, local anesthetics at concentrations that do not block nerve conduction substantially affect ongoing central changes in pain processing that are induced by a real tissue trauma. A significant preemptive effect could not be demonstrated. The anti-hyperalgesic effect of lidocaine is likely based on action of central (spinal) sites, but peripheral sites may also be addressed.
Authors:
H Holthusen; S Irsfeld; P Lipfert
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Pain     Volume:  88     ISSN:  0304-3959     ISO Abbreviation:  Pain     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2001-01-25     Completed Date:  2001-01-26     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7508686     Medline TA:  Pain     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  295-302     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Heinrich-Heine-University, Duesseldorf, Germany. holthusen@med.uni-duesseldorf.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Anesthetics, Local / administration & dosage*
Burns / drug therapy*
Cross-Over Studies
Double-Blind Method
Hot Temperature
Humans
Hyperalgesia / drug therapy*
Lidocaine / administration & dosage*
Male
Pain Threshold / drug effects*
Statistics, Nonparametric
Wounds and Injuries / drug therapy
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 137-58-6/Lidocaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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