Ness Timothy J, Randich Alan
Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL 35205, USA.
Reg Anesth Pain Med. 2006 May-Jun;31(3):248-53. doi: 10.1016/j.rapm.2006.02.009.
Intravenous lidocaine (IVL) produces analgesia in multiple painful disorders. The neurophysiological effects of IVL are not well defined, but studies in visceral nociceptive systems have shown that IVL has differential effects on subgroups of spinal neurons. The present study determined whether a similar differential effect of IVL occurs in spinal neurons excited by noxious cutaneous stimuli.
In decerebrate, cervical spinal cord-transected rats, the lumbosacral spinal cord was exposed by a laminectomy. Single-unit recordings were made of dorsal horn neurons excited by noxious cutaneous stimuli. Each neuron's response to noxious (pinch) and nonnoxious (brush) cutaneous stimuli were determined and the effect of a counterirritation stimulus (noxious skin pinch presented in the upper body) on spontaneous activity quantified. In a subset of neurons, sequential doses of IVL were administered, and responses of each neuron to repeated 50 degrees C heating of the hindpaw/tail were determined.
IVL dose-dependently inhibited neurons excited by heating of the hindpaw/tail. IVL produced significantly greater inhibition of both spontaneous and heat-evoked activity in neurons that did not show counterirritation effects when compared with those neurons that did show counterirritation effects. Standard classification of neurons as wide-dynamic range or nociceptive-specific was less predictive of the IVL effect.
IVL had differential inhibitory effects on 2 spinal cutaneous nociceptive neuron populations. Other drugs could also have differential effects on sensory pathways, suggesting a mechanism whereby certain drugs differentially affect different types of pain.
静脉注射利多卡因(IVL)可在多种疼痛性疾病中产生镇痛作用。IVL的神经生理效应尚未明确界定,但在内脏伤害性感受系统的研究表明,IVL对脊髓神经元亚群有不同的影响。本研究确定IVL在由有害皮肤刺激激发的脊髓神经元中是否也会产生类似的差异效应。
在去大脑、颈髓横断的大鼠中,通过椎板切除术暴露腰骶部脊髓。对由有害皮肤刺激激发的背角神经元进行单单位记录。确定每个神经元对有害(捏)和无害(刷)皮肤刺激的反应,并量化反刺激刺激(上身出现的有害皮肤捏)对自发活动的影响。在一部分神经元中,给予连续剂量的IVL,并确定每个神经元对后爪/尾巴重复50摄氏度加热的反应。
IVL剂量依赖性地抑制由后爪/尾巴加热激发的神经元。与显示反刺激效应的神经元相比,IVL对未显示反刺激效应的神经元的自发活动和热诱发活动产生了显著更大的抑制作用。将神经元标准分类为广动力范围或伤害性特异性对IVL效应的预测性较差。
IVL对两种脊髓皮肤伤害性感受神经元群体有不同的抑制作用。其他药物也可能对感觉通路有不同的影响,提示一种机制,即某些药物对不同类型的疼痛有不同的影响。