Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia
Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia
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DOI：
10.1213/01.ane.0000078811.80093.88
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发表时间：
2003-09-01
影响因子：
5.7
通讯作者：
Eisenach, JC
中科院分区：
文献类型：
--
作者：
Hood, DD;Curry, R;Eisenach, JC
手术期间使用阿片类药物可能有益于预防术后疼痛，也可能有害，因为引起急性耐受。我们在志愿者中使用了稳定的痛觉过敏模型来测试急性阿片类药物暴露是否也会导致人类在数小时内产生这种疼痛敏感性。对十名健康志愿者进行了研究。通过局部施用辣椒素加上间歇加热来诱导机械性痛觉过敏和异常性疼痛区域。计算机控制的静脉注射瑞芬太尼滴定至目标血浆浓度，使有害热引起的疼痛报告减少 70%，并维持在该水平 60-100 分钟。在瑞芬太尼输注期间和之后测量痛觉过敏和异常性疼痛的面积。输注期间瑞芬太尼（目标浓度为 3.1 +/- 1.2 ng/mL）使痛觉过敏和异常性疼痛面积分别减少 33% +/- 31% 和 65% +/- 28%（P < 0.05）。停止瑞芬太尼4小时后，痛觉过敏和异常性疼痛面积持续扩大，分别达到180%+/-47%和180%+/-86%。这项研究表明，急性阿片类药物暴露会在暴露后数小时内增强过敏反应。如果适用于手术环境，这可能会增加术后镇痛所需的阿片类药物剂量，并增强而不是抑制术后疼痛。
Opioids administered during surgery maybe beneficial by preempting postoperative pain or detrimental by causing acute tolerance. We used a stable model of hyperalgesia in volunteers to test whether acute opioid exposure also results in such pain sensitization over a period of hours in humans. Ten healthy volunteers were studied. Areas of mechanical hyperalgesia and allodynia were induced by topical capsaicin application plus intermittent heating. Computer-controlled IV remifentanil infusion was titrated to a targeted plasma concentration that reduced pain report to noxious heat by 70% and was maintained at this level for 60-100 min. Areas of hyperalgesia and allodynia were measured during and after remifentanil infusion. Remifentanil (targeted concentration of 3.1 +/- 1.2 ng/mL) reduced areas of hyperalgesia and allodynia by 33% +/- 31% and 65% +/- 28%, respectively, during infusion (P < 0.05). Areas of hyperalgesia and allodynia continuously enlarged 4 h after remifentanil was stopped, to 180% +/- 47% and 180% +/- 86%, respectively. This study demonstrates that acute opioid exposure enhances hypersensitivity for hours after exposure. If applicable to the surgical setting, this could increase the dose of opioid required for postoperative analgesia and enhance, rather than inhibit, postoperative pain.