British Journal of Anaesthesia, Vol 76, Issue 6 816-821, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
OHG. Wilder-Smith, E. Tassonyi, C. Senly, P. Otten and L. Arendt-Nielsen
Nociception can produce segmental spinal sensitization or descending
supraspinal antinociception. We assessed both types of sensory change after
surgery during isoflurane-nitrous oxide anaesthesia with or without
fentanyl before nociception. Patients undergoing back surgery received
fentanyl 3 micrograms kg-1 (n = 15) or placebo (n = 15) before anaesthesia
in a prospective, randomized, blinded study. Sensation, pain detection and
tolerance thresholds to electrical stimulation were measured before
operation at the arm, incision and herniated disc dermatomes (HDD) and 1,
2, 4, 6, 24 h and 5 days after operation, together with pain scores and
patient-controlled morphine consumption (duration 24 h). For segmental
effects, thresholds were normalized to the thresholds at a distant
dermatome (arm). Raw pain thresholds were increased after operation
(fentanyl > placebo) and were maximal at 4 h (pain tolerance in HDD:
fentanyl +5.2 mA (+62.7%), placebo, +3.8 mA (+44.2%); P < 0.05 vs
baseline for both). Normalized sensation thresholds decreased for placebo
only (HDD/4 h: placebo, -1.8 (-44.8%), P < 0.05; fentanyl, +0.1 (+5.5%)
ns). All changes returned to baseline by 24 h except for the placebo group
normalized HDD sensation (d5: placebo, -2.4 (-59.7)%, P < 0.05; fentanyl
-0.1 (-5.5%) ns). Pain scores and morphine consumption were similar. The
study demonstrated both supraspinal analgesia and spinal sensitization
after surgery. Fentanyl administration before operation augmented the
former while decreasing the latter, and hence sensitization, especially if
neuropathic, may particularly benefit from pre-emptive analgesia.
CLINICAL INVESTIGATIONS
Surgical pain is followed not only by spinal sensitization but also by supraspinal antinociception
Department of Anaesthesiology, Geneva University Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland; Department of Neurosurgery, Geneva University Hospital, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland; Centre for Sensory-Motor Interaction, Laboratory for Experimental Pain Research, University of Aalborg, Fredrik Bajersvej 7D, DK-9220 Aalborg E, Denmark
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