Differential effects of alfentanil, fentanyl, pethidine and lignocaine administered intrathecally on nociceptive responses evoked by low and high frequency stimulation of somatic nerves.

We have studied in anaesthetized dogs the effects of alfentanil, fentanyl, pethidine and lignocaine administered intrathecally on nociceptive responses evoked by low and high frequency supramaximal electrical stimulation of the tibial and radial nerves. Doses were selected to abolish both A delta and C fibre somatosympathetic reflexes to single stimuli. Pethidine and lignocaine eliminated reflex pressor and heart rate responses to repeated single stimuli and almost completely abolished responses to train stimulation. The pressor response to single stimuli was abolished by fentanyl and reduced by alfentanil, but these drugs did not reduce significantly this response to train stimulation, suggesting a stimulation rate-dependent effect. Of the opioids, only pethidine had an effect comparable to that of lignocaine. The absence of sympathetic block and antagonism by naloxone imply a lack of significant local anaesthetic effect. We suggest that the greater analgesic efficacy of pethidine is a result of endogenous synergism between a minor local anaesthetic and a major opioid effect.

[1]  D. Galletly,et al.  Relative effects of intrathecal administration of fentanyl and midazolam on aδ and c fibre reflexes , 1992, Neuropharmacology.

[2]  J. Whitwam,et al.  Effect of low and high concentrations of alfentanil administered intrathecally on A delta and C fibre mediated somatosympathetic reflexes. , 1992, British journal of anaesthesia.

[3]  B. Leighton,et al.  Intrathecal meperidine for labor analgesia: preliminary communication. , 1992, International journal of obstetric anesthesia.

[4]  A. Bader,et al.  Spinal anesthesia for cesarean delivery with meperidine as the sole agent. , 1992, International journal of obstetric anesthesia.

[5]  A. Dickenson,et al.  Spinal local anaesthetic actions on afferent evoked responses and wind-up of nociceptive neurones in the rat spinal cord: combination with morphine produces marked potentiation of antinociception , 1992, Pain.

[6]  R. Lewis,et al.  Pethidine as a spinal anaesthetic agent--a comparison with plain bupivacaine in patients undergoing transurethral resection of the prostate. , 1992, European journal of anaesthesiology.

[7]  A. Dickenson.  Mechanisms of the analgesic actions of opiates and opioids. , 1991, British medical bulletin.

[8]  J. Meynadier,et al.  Regional Opioid Analgesia: Physiopharmacological Basis, Drugs, Equipment and Clinical Application , 1991 .

[9]  S. Datta,et al.  Continuous microcatheter spinal anesthesia with subarachnoid meperidine for labor and delivery. , 1990, Anesthesia and analgesia.

[10]  N. Manago,et al.  Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor. , 1990, Anesthesiology.

[11]  N. Rawal.  Indications for the Use of Intraspinal Opioids , 1990 .

[12]  J. Jaffe,et al.  Opioid analgesics and antagonists , 1990 .

[13]  L. Kitahata,et al.  Spinal Cord Distribution of 3H‐Morphine after Intrathecal Administration: Relationship to Analgesia , 1989, Anesthesia and analgesia.

[14]  Michael J. Cousins,et al.  Neural Blockade in Clinical Anesthesia and Management of Pain , 1988 .

[15]  M. Cousins.  The spinal route of analgesia for acute and chronic pain , 1987, PAIN.

[16]  S. Sangarlangkarn,et al.  Meperidine as a Spinal Anesthetic Agent: A Comparison with Lidocaine‐Glucose , 1987, Anesthesia and analgesia.

[17]  G. Albright,et al.  EPIDURAL FENTANYL/BUPIVACAINE COMBINATIONS FOR LABOR ANALGESIA: EFFECT OF VARYING DOSAGES , 1986 .

[18]  É. Lörinczi,et al.  Saddle block with pethidine for perineal operations. , 1986, British journal of anaesthesia.

[19]  T. Yaksh,et al.  The physiology and pharmacology of spinal opiates. , 1985, Annual review of pharmacology and toxicology.

[20]  L. Mather,et al.  Intrathecal and epidural administration of opioids. , 1984, Anesthesiology.

[21]  R. Przewłocki,et al.  Opiate receptor binding sites in human spinal cord , 1983, Brain Research.

[22]  A. Baraka,et al.  Epidural Meperidine‐Bupivacaine for Obstetric Analgesia , 1982, Anesthesia and analgesia.

[23]  D. Justins,et al.  A Controlled Trial of Extradural Fentanyl in Labour , 1982, British journal of anaesthesia.

[24]  Roger L. Black,et al.  Goodman and Gilman's The Pharmacological Basis of Therapeutics , 1991 .

[25]  J. Whitwam,et al.  Responses in sympathetic nerves of the dog evoked by stimulation of somatic nerves , 1979, Brain Research.

[26]  R. Schmidt,et al.  Somatosympathetic reflexes: afferent fibers, central pathways, discharge characteristics. , 1973, Physiological reviews.

[27]  B. Johansson.  Circulatory responses to stimulation of somatic afferents with special reference to depressor effects from muscle nerves. , 1962, Acta physiologica Scandinavica. Supplementum.

[28]  E. Way.  Studies on the local anesthetic properties of isonipecaine. , 1946, Journal of the American Pharmaceutical Association. American Pharmaceutical Association.

[29]  G. Gordon,et al.  The mechanism of the vasomotor reflexes produced by stimulating mammalian sensory nerves , 1943, The Journal of physiology.