title: The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl.
abstract: The study was performed to determine whether epidural fentanyl produced segmental sensory changes to electrical stimulation at different frequencies. Eight healthy volunteers received fentanyl 1 microgram/kg both intravenously and epidurally in a randomized, double-blind, cross-over fashion. Perception thresholds and amount of current required to elicit a predetermined level of moderate pain (Cmp) at 5,250, and 2000 Hz stimulation were measured at ipsilateral dermatomes C2 and L2 at 0, 5, 15, 30, 45, and 60 min after injection. Perceptions to 5,250, and 2000 Hz stimulation were unaffected by either intravenous or epidural fentanyl (P > 0.08). Intravenous fentanyl increased Cmp at both 5 and 250 Hz at both dermatomes (P < 0.004) and thus did not produce segmental analgesia. In contrast, epidural fentanyl increased Cmp only at the L2 dermatome and only at 5 Hz (P = 0.005). We conclude that an epidural bolus of fentanyl results in segmental spinal analgesia to transcutaneous electrical stimulation only at specific frequencies. Furthermore, pain produced by stimulation at 5 Hz may have a different pharmacology than pain produced by 250 Hz stimulation.
authors.affiliation: Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Liu
authors.forename: J C
authors.initials: JC
authors.lastname: Gerancher
authors.forename: B G
authors.initials: BG
authors.lastname: Bainton
authors.forename: D J
authors.initials: DJ
authors.lastname: Kopacz
authors.forename: R L
authors.initials: RL
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D059408:Pain Management; D017288:Pain Threshold / Q000187:drug effects*; D010465:Perception / Q000187:drug effects*; D004561:Transcutaneous Electric Nerve Stimulation
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl