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REGIONAL ANESTHESIA AND PAIN MEDICINE

The Effect of Systemic Lidocaine on Pain and Secondary Hyperalgesia Associated with the Heat/Capsaicin Sensitization Model in Healthy Volunteers

Jesper Dirks, MD^*, Peder Fabricius, MD^*, Karin L. Petersen, MD, Michael C. Rowbotham, MD^,, and Jørgen B. Dahl, MD, PhD^*

*Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark; and Departments of Neurology and Anesthesia, University of California, San Francisco, California

Address correspondence and reprint requests to Jesper Dirks, MD, Department of Anaesthesiology, Herlev University Hospital, DK-2730 Herlev, Denmark.

Although effective in neuropathic pain, the efficacy of systemic lidocaine in non-neuropathic pain remains uncertain. We investigated the analgesic effect of systemic lidocaine on the heat/capsaicin sensitization model of experimental pain in 24 volunteers. Sensitization was produced by heating the skin to 45°C for 5 min, followed by a 30-min application of 0.075% capsaicin cream, and maintained by periodically reheating the sensitized skin. Subjects received IV lidocaine (bolus 2 mg/kg, then infusion 3 mg · kg · h), or saline for 85 min. Areas of secondary hyperalgesia, heat pain detection thresholds, and painfulness of stimulation with 45°C for 1 min (long thermal stimulation) were quantified. Systemic lidocaine reduced the area of secondary hyperalgesia to brush, but not to von Frey hair stimulation. Lidocaine did not alter heat pain detection thresholds or painfulness of long thermal stimulation in normal skin. We conclude that, at infusion rates in the low- to mid-antiarrhythmic range, lidocaine has no effect on acute nociceptive pain but does have a limited and selective effect on secondary hyperalgesia.

Implications: The efficacy of systemic lidocaine in nonneuropathic pain remains uncertain. This study investigates the effect of systemic lidocaine on experimental-induced hyperalgesia in 25 volunteers. Hyperalgesia was induced by using an experimental pain model that uses heat and capsaicin in combination. Systemic lidocaine showed a selective effect on secondary hyperalgesia.

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