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REGIONAL ANESTHESIA AND PAIN MEDICINE

The Current Perception Thresholds Vary Between Horizontal and 70° Tilt-Up Positions

Osamu Shimoda, MD, PhD^*, and Yoshihiro Ikuta, MD, PhD

*Department of Anesthesiology, Kumamoto University School of Medicine; and Surgical Center, Kumamoto University Hospital, Kumamoto, Japan

Address correspondence and reprint requests to Osamu Shimoda, MD, Department of Anesthesiology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-8556, Japan. Address e-mail requests to shimoda{at}kaiju.medic.kumamoto-u.ac.jp

We investigated the influence of posture on current perception threshold (CPT). The subjects consisted of 20 healthy male volunteers (23–31 yr old). At both the horizontal and the 70° tilt-up position (TUP), the CPTs (5, 250, and 2000 Hz) of the middle finger were determined by using the Neurometer CPT/C (Neuropteran, Baltimore, MD). Autonomic nervous activities were evaluated by heart rate variability (HRV) analysis and spontaneous baroreflex sensitivity analysis at the two postures previously mentioned. The three CPTs at the 70° TUP were significantly lower than those at the horizontal posture (5 Hz, P < 0.05; 250 Hz, P < 0.001; 2000 Hz, P < 0.05). The changes in HRV and spontaneous baroreflex sensitivity at the 70° TUP indicated decreasing parasympathetic tone. The CPTs of 5 and 250 Hz were significantly correlated with mean systolic blood pressure at the 70° TUP. The CPT of 2000 Hz was significantly correlated with the 0.15–0.4 Hz component in HRV at both postures. The regression analysis of the difference of 5 Hz CPT with that of the mean systolic blood pressure showed a significant correlation (P < 0.001). To evaluate the clinical course of peripheral nerve disorders, the comparison of CPTs measured during the same posture is important. This suggests that CPTs must be measured at the horizontal posture.

Implications: Current perception thresholds at the 70° tilt-up posture were significantly lower than those at the horizontal posture. When the compensatory mechanism for preserving blood pressure was emphasized, the current perception thresholds would have a relational connection to mean systolic blood pressure, similar to the concept of hypertension-induced hypoalgesia.

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