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Intradermal sufentanil does not improve lidocaine-induced local anesthesia

[L’administration intradermique de sufentanil n’améliore pas l’anesthésie locale induite par la lidocaïne]

Maximilian W.B. Hartmannsgruber, MD^*, Peter G. Atanassoff, MD^*, Arne Budde, MD^*, Sorin J. Brull, MD, Zeev N. Kain, MD^* and David G. Silverman, MD^*

^* From the Departments of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, and
The University Of Arkansas For Medical Sciences, Little Rock, Arkansas, USA.

Address correspondence to: Dr. Peter G. Atanassoff, Department of Anesthesiology, Yale University School of Medicine, P.O. Box 208051, New Haven, Connecticut 06520-8051, USA. Phone: 203-785-2802; Fax: 203-785-6664; E-mail: peter.atanassoff{at}yale.edu

Purpose: Peripheral opioid receptors may result in antinociceptive effects when occupied by opioids. This study examined intradermally injected sufentanil (S), a highly lipid soluble opioid, administered with and without lidocaine (L), in a thermal pain model.

Methods: Nine volunteers were instructed on the method of magnitude estimation of pain before undergoing baseline testing with seven seconds thermal stimuli between 44 and 52°C, delivered by a contact thermal stimulator at five cutaneous forearm sites. Then, four sites randomly received injections of equal volumes (0.1 mL) of either normal saline (NS), lidocaine 0.5% (L), sufentanil 0.75 µg (S), lidocaine 0.5% plus sufentanil 0.75 µg (L+S), and one site was not injected and served as reference (REF). Testing was repeated at six, 30, 60, 90, 120, and 150 min following injection. The pain elicited by each stimulus was normalized to the subject’s response to the 50°C stimulus at the REF site.

Results: Baseline testing showed small (P = ns) differences in pain scores. At six minutes, the lidocaine sites (L, L+S) had pain scores that were mean 83% (range 78–88%) lower than the other sites (P < 0.05), but there was no difference between the L and L+S sites or between the S and NS or REF sites. At 30 and 60 min these pain scores were mean 38% (29–44%) and 20% (8–30%) less than at the REF, NS, and S sites (P = ns). At 90 min and later times, the pain scores had returned to baseline.

Conclusions: These results suggest that intradermal sufentanil alone has no analgesic effect. Further, in combination with lidocaine, sufentanil does neither potentiate nor prolong the analgesic effect of lidocaine.