Sensory changes and pain after abdominal hysterectomy: a comparison of anesthetic supplementation with fentanyl versus magnesium or ketamine.
Drugs interacting with opioid or N-methyl-D-aspartate (NMDA) receptors may have differing effects on post-surgical sensory changes, such as central inhibition or spinal excitation. We compared the effect of supplementing isoflurane/N2O/O2 anesthesia with an opioid agonist (fentanyl [n = 15]) or two drugs inhibiting the NMDA system differently (magnesium, ketamine [n = 15 in each group]) on sensory changes after abdominal hysterectomy. Electric sensation, pain detection, and pain tolerance thresholds were determined (preoperatively and 1, 4, 24 h, and 5 days postoperatively) in arm, thoracic, incision, and leg dermatomes together with pain scores and cumulative morphine consumption. Thresholds relative to the arm were derived to unmask segmental sensory changes hidden by generalized changes. Absolute thresholds were increased 1-24 h, returning to baseline on Day 5, without overall differences among drugs. Fentanyl thresholds were lower 1 h and higher 5 days postoperatively compared with magnesium and ketamine; thresholds were lower at 24 h for magnesium versus ketamine. Relative thresholds increased compared with baseline only with fentanyl (1-4 h); none decreased. Pain scores and morphine consumption were similar. Thus, all adjuvants suppressed spinal sensitization after surgery. Fentanyl showed the most, and magnesium the least, central sensory inhibition up to 5 days postoperatively, with different patterns of inhibition directly postsurgery versus later. Differences in sensory processing were not reflected in clinical measures.


CONCLUSIONS
We studied the effects on postsurgical sensory processing of general anesthesia supplemented by drugs affecting opioid or N-methyl-D-aspartate receptors using sensory thresholds. Generalized central sensory inhibition, differently affected by the drugs, predominated after surgery. All drugs suppressed spinal excitation. Clinical pain measures did not reflect sensory change.
Wilder-Smith
O H
OH
Department of Anaesthesiology, Geneva University Hospital, Switzerland. OHWS@thenet.ch
Arendt-Nielsen
L
L
Gäumann
D
D
Tassonyi
E
E
Rifat
K R
KR
D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006801:Humans; D007044:Hysterectomy; D007649:Ketamine / Q000494:pharmacology*; D008274:Magnesium / Q000494:pharmacology*; D008875:Middle Aged; D017288:Pain Threshold / Q000187:drug effects*; D011446:Prospective Studies; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors*; D012677:Sensation / Q000187:drug effects*
D000701:Analgesics, Opioid; D016194:Receptors, N-Methyl-D-Aspartate; D007649:Ketamine; D008274:Magnesium; D005283:Fentanyl