Temporal summation during extradural anaesthesia

Curatolo, Michele; Petersen-Felix, Steen; Arendt‐Nielsen, Lars; Fischer, Michael J.M.; Zbinden, A. M.

doi:10.1093/bja/75.5.634

Cited by 45 publications

(32 citation statements)

References 7 publications

(8 reference statements)

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“…In a previous investigation, 6 we found that even extradural anaesthesia did not completely block temporal summation of repeated electrical stimuli: pain to repeated stimuli was blocked in only one of 10 patients, and pain thresholds to repeated stimuli were significantly lower than pain thresholds to a single stimulus.…”

Section: Discussionmentioning

confidence: 60%

Spinal anaesthesia inhibits central temporal summation

Curatolo¹,

Petersen-Felix²,

Arendt‐Nielsen³

et al. 1997

British Journal of Anaesthesia

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SummaryIn a previous investigation we found that extradural anaesthesia did not adequately inhibit temporal summation of repeated electrical stimuli: pain to repeated stimuli was blocked in only one of 10 patients, and pain thresholds to repeated stimuli were significantly lower than pain thresholds to a single stimulus. In this study we have investigated in 10 patients the effect of spinal anaesthesia on temporal summation, assessed by repeated electrical stimulation of the sural nerve. Plain 0.5% bupivacaine 18 mg was injected at L2-3. The pain threshold to a single electrical stimulus, summation threshold (increase in perception during repeated electrical stimuli with five impulses of the same intensity at 2 Hz), pinprick and cold sensation were assessed. After spinal anaesthesia, pain to both single and repeated stimulation, and pinprick and cold sensation, disappeared in all patients. We conclude that spinal anaesthesia inhibits temporal summation elicited by repeated electrical stimulation. (Br. J. Anaesth. 1997; 78: 88-89) Key words Anaesthetic techniques, subarachnoid. Pain, experimental. Pain, threshold.Repetition of a peripheral stimulus can cause increased pain perception (temporal summation). Increased and prolonged firing of dorsal horn neurones after repeated stimulation 1 (central sensitization) is probably the mechanism explaining temporal summation.Repeated cutaneous stimulation can be used to investigate temporal summation in humans.2 Nociceptive reflex and subjective pain thresholds after repeated stimulation have been found to be increased slightly by isoflurane concentrations used for surgical analgesia, 3 ketamine 4 and alfentanil, 5 although none of these drugs adequately blocked temporal summation. In a previous investigation, 6 we found that even extradural anaesthesia did not completely block temporal summation of repeated electrical stimuli: pain to repeated stimuli was blocked in only one of 10 patients, and pain thresholds to repeated stimuli were significantly lower than pain thresholds to a single stimulus.The aim of this study was to assess the effect of spinal anaesthesia on temporal summation, assessed by repeated electrical stimulation. Methods and resultsWe studied 10 ASA I-II patients (five male), median age 43 (range 18-54) yr, median body weight 71 (54-85) kg and median height 170 (157-182) cm, undergoing spinal anaesthesia for elective surgery. Exclusion criteria were: age less than 18 or more than 65 yr, heart disease, pregnancy, opioid intake during the last 2 weeks, intake of other analgesics during the last 24 h, alcohol abuse and use of psychotropic drugs. The study was approved by the local Ethics Committee and informed consent was obtained from all patients. Patients were not premedicated. Spinal anaesthesia was performed in the sitting position, at L2-3, with a 27-gauge Quincke needle, by the midline approach. Plain 0.5% bupivacaine 18 mg was injected over 40-45 s, with the bevel of the needle pointing cranially. Cerebrospinal fluid (0.2 ml) was aspirated and r...

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Section: Discussionmentioning

confidence: 60%

Spinal anaesthesia inhibits central temporal summation

Curatolo¹,

Petersen-Felix²,

Arendt‐Nielsen³

et al. 1997

British Journal of Anaesthesia

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“…Temporal summation is not blocked by 0.5% bupivacaine epidural anesthesia, 12 contrary to spinal anesthesia with plain bupivacaine 0.5% where the pain response to repeated stimulation disappeared at the sural nerve. 13 Our results suggest that epidural anesthesia with alkalinized 2% lidocaine and epinephrine may inhibit temporal summation also.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 72%

Epidural bolus injection with alkalinized lidocaine improves blockade of the first sacral segment — a brief report

Arakawa

Aoyama

Ohe

2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : It has been reported that the addition of epinephrine and/or bicarbonate to local anesthetic enhances the depth of epidural blockade and that initial partial bolus injection results in greater caudal spread. We evaluated the anesthetic effects of lidocaine with epinephrine and/or bicarbonate injected into the epidural space by bolus or catheter injection.M Me et th ho od ds s: : Forty-four patients undergoing epidural anesthesia with 17 mL of 2% lidocaine containing 1:200,000 epinephrine at L4-5 or L5-S1 were randomly divided into four groups. Lidocaine was administrated via epidural catheter [lidocaine catheter (LC) group] or Tuohy needle (lidocaine bolus group), lidocaine-bicarbonate was administrated via catheter (lidocaine-bicarbonate catheter group) or needle [lidocaine-bicarbonate bolus (LBB) group]. Pain threshold after repeated electrical stimulation was performed at L2 and S1 regions. Motor blockade was evaluated using the Bromage scale. Sympathetic blockade was assessed with plethysmographic waveforms from the toe.

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“…Described first in cats by Sherrington at the beginning of the last century (Sherrington 1910), the NWR has been extensively applied for the study of experimental nociception in laboratory animals (Schouenborg andKalliomaki 1990, Leandri et al 2011) and human beings (Schouenborg and Kalliomaki 1990, Curatolo et al 1995, Andersen et al 2001, Banic et al 2004, Neziri et al 2010, Leandri et al 2011). …”

Section: The Physiology Of the Nociceptive Withdrawal Reflexmentioning

confidence: 99%

“…Transcutaneous electrical stimulation of a limb peripheral nerve is usually applied to evoke the NWR (Willer 1977, Curatolo et al 1995. Electrical stimulation is easy to use and adequate to elicit stable and reproducible reflexes, bypassing the influence of peripheral transduction mechanisms.…”

Section: Eliciting and Recording The Nwr In Horsesmentioning

confidence: 99%

“…The facilitation is accompanied by increasing pain perception for successive stimuli of the same intensity, indicating that a summation of sensory inputs occurs over time. Since its first description this model has been employed extensively to test the efficacy of analgesic drugs and procedures in humans (Curatolo et al 1995, Curatolo et al 1997. Inhibition of temporal summation has been indicated as a major goal in pain prevention and treatment.…”

Section: Temporal Summation: Background and Experiences In Horsesmentioning

confidence: 99%

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The model of the Nociceptive Withdrawal Reflex in horses

Spadavecchia¹,

Rohrbach²,

Levionnois³

et al. 2016

PHK

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Summary: In equine pain research, the Nociceptive Withdrawal Reflex (NWR) model has been proposed as an alternative to classical thermal, mechanical and electrical models to investigate the physiology of nociception. This model does not only allow a more reliable definition of the nociceptive threshold through neurophysiological characterization of the elicited response , but also consents plotting a stimulus-response curve as well as the evaluation of temporal summation mechanisms. Aim of this report is to summarize the experience and results obtained using the NWR model in horses over the last 15 years, firstly with the purpose of describing its physiological characteristics and secondly with the aim of evaluating its pharmacological modulation through analgesic and anaesthetic compounds. The NWR can be elicited in horses through electrical transcutaneous stimulation of a peripheral sensory nerve and is recorded through electromyographic electrodes from the muscles involved in the withdrawal reaction. As the non-nociceptive fibres have lower threshold to electrical stimuli than the nociceptive one, it is impossible to differentiate between the two groups on the stimulus side. So, the only guidance to assess the quality of the stimulus and the recruitment of nociceptive afferents should rely on the characteristics of the electromyographic response, most of all on the timing of its various components. A reflex response can be considered to be a true NWR only if it appears within a time epoch compatible with the conduction velocity of the A fibers. Furthermore a clearly recognizable EMG burst in the epoch of interest has to be accompanied by a consistent aversive behavioural reaction, thus allowing the definition of a reliable NWR threshold. Responses to stimulation intensities below and above thresholds can be quantified to draw a stimulus response curve. Furthermore, through repeated stimulation at subthreshold intensities, it is possible to elicit the phenomenon of temporal summation, considered to be the early phase of the wind up phenomenon and of relevant interest to study central integrative mechanisms of pain processing. Alpha-2 agonists, opioids, systemic lidocaine, ketamine and inhalation anaesthetics have been investigated using the NWR model in horses. Drug-specific modulation of NWR threshold, stimulus-response curves and temporal summation are summarized for each tested compound.

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Temporal summation during extradural anaesthesia

Cited by 45 publications

References 7 publications

Spinal anaesthesia inhibits central temporal summation

Spinal anaesthesia inhibits central temporal summation

Epidural bolus injection with alkalinized lidocaine improves blockade of the first sacral segment — a brief report

The model of the Nociceptive Withdrawal Reflex in horses

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