title: Low-dose lidocaine suppresses experimentally induced hyperalgesia in humans.
abstract: BACKGROUND
  The antinociceptive effects of systemically administered local anesthetics have been shown in various conditions, such as neuralgia, polyneuropathy, fibromyalgia, and postoperative pain. The objective of the study was to identify the peripheral mechanisms of action of low-dose local anesthetics in a model of experimental pain.
  
  
  METHODS
  In a first experimental trial, participants (n=12) received lidocaine systemically (a bolus injection of 2 mg/kg in 10 min followed by an intravenous infusion of 2 mg x kg(-1) x h(-1) for another 50 min). In a second trial, modified intravenous regional anesthesia was administered to exclude possible central analgesic effects. In one arm, patients received an infusion of 40 ml lidocaine, 0.05%; in their other arm, 40 ml NaCl, 0.9%, served as a control. In both trials, calibrated tonic and phasic mechanical and chemical (histamine) stimuli were applied to determine differentially the impairment of tactile and nociceptive perception.
  
  
  RESULTS
  Mechanical sensitivity to touch, phasic mechanical stimuli of noxious intensity, and heat pain thresholds remained unchanged after systemic and regional application of the anesthetic. In contrast, histamine-induced itch (intravenous regional anesthesia), axon reflex flare (systemic treatment), and development of acute mechanical hyperalgesia during tonic pressure (12 N; 2 min) of an interdigital web was significantly suppressed after both treatments.
  
  
  CONCLUSIONS
  Increasing painfulness during sustained pinching has been attributed to excitation and simultaneous sensitization of particular Adelta- and C-nociceptors. This hyperalgesic mechanism seems to be particularly sensitive to low concentrations of lidocaine. These findings confirm clinical experience with lidocaine in pain states dominated by hyperalgesia.
authors.affiliation: Department of Anesthesiology, University of Erlangen-Nuremberg, Nuremberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Koppert
authors.forename: S
authors.initials: S
authors.lastname: Zeck
authors.forename: R
authors.initials: R
authors.lastname: Sittl
authors.forename: R
authors.initials: R
authors.lastname: Likar
authors.forename: R
authors.initials: R
authors.lastname: Knoll
authors.forename: M
authors.initials: M
authors.lastname: Schmelz
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001369:Axons / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006632:Histamine / Q000008:administration & dosage / Q000633:toxicity; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007478:Iontophoresis; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D010812:Physical Stimulation; D011312:Pressure; D014110:Touch / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D006632:Histamine; D008012:Lidocaine