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Perioperative intravenous adenosine infusion to extend postoperative analgesia in brachial plexus block

Published online by Cambridge University Press:  11 July 2005

A. Apan ,
S. Ozcan ,
U. Buyukkocak ,
O. Anbarci  and
H. Basar
A. Apan
Affiliation:
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey
S. Ozcan
Affiliation:
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey
U. Buyukkocak
Affiliation:
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey
O. Anbarci
Affiliation:
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey
H. Basar
Affiliation:
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey
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Abstract

Summary

Background and objective: Adenosine infusions have been shown to reduce requirements of anaesthetics, to decrease the need for postoperative analgesics and to attenuate hyperaesthesia related to neuropathic pain. We decided to investigate the effects, beneficial or otherwise, of an adenosine infusion administered during surgery. A brachial plexus block was used to produce anaesthesia for the surgery.

Methods: Sixty adults undergoing upper extremity surgery were included in the study. Brachial plexus block was performed via an axillary approach with lidocaine 1.25% and epinephrine 1/200 000 (40 mL). Patients were randomly assigned to two groups. During surgery, saline (control) or adenosine 80 μg kg min was infused intravenously in a double-blind fashion for 1 h. Visual analogue scores every 4 h, analgesic consumption, time to first spontaneous pain sensation, time to first rescue analgesic and adverse effects were noted during the first 24 h.

Results: Vital signs were stable in both groups throughout surgery. During the adenosine infusion, one patient fainted while another complained of palpitations and tightness of the chest; both patients were excluded from further analyses. The time to first sensation of pain was significantly longer in the adenosine group compared to the control group (438 ± 387 vs. 290 ± 227 min, P = 0.02). The time to first rescue analgesic, the visual analogue scale scores and analgesic consumption in the postoperative period were similar.

Conclusions: In patients undergoing surgery with an axillary plexus block, a perioperative adenosine infusion prolongs the duration of postoperative analgesia to some extent. However, the time to first rescue analgesic, total analgesic requirements and pain scores were unchanged; the risk of potentially serious adverse effects is high. This therapy cannot be recommended.

Keywords

ANAESTHESIA, CONDUCTION, nerve block, brachial plexusNEUROTRANSMITTERS, adenosinePOSTOPERATIVE COMPLICATIONS, painSPINAL NERVES, brachial plexus
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 916 - 919
Copyright
2003 European Society of Anaesthesiology

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References

Sawynok J, Sweeney MI. The role of purines in nociception. Neuroscience 1989; 32: 557–569.Google Scholar
Holmgren M, Hedner J, Mellstrand T, Nordberg G, Hedner T. Characterisation of the antinociceptive effects of some adenosine analogues in the rat. Naunyn-Schmideberg's Arch Pharmacol 1986; 334: 290–293.Google Scholar
Herrick-Davis K, Chippari S, Luttinger D, Ward SJ. Evaluation of adenosine agonists as potential analgesics. Eur J Pharmacol 1989; 162: 365–369.Google Scholar
Lee YW, Yaksh TL. Pharmacology of the spinal adenosine receptor which mediates the antiallodynic action of intrathecal adenosine agonists. J Pharmacol Exp Ther 1996; 277: 1642–1649.Google Scholar
Doi T, Kuzuna S, Maki Y. Spinal antinociceptive effects of adenosine compounds in mice. Eur J Pharmacol 1987; 137: 227–231.Google Scholar
Sweeney MI, White TD, Sawynok J. Involvement of adenosine in the spinal antinociceptive effects of morphine and norepinephrine. J Pharmacol Exp Ther 1987; 243: 657–665.Google Scholar
Chiari A, Eisenach JC. Intrathecal adenosine: interactions with spinal clonidine and neostigmine in rat model of acute nociception and postoperative hypersensitivity. Anesthesiology 1999; 90: 1413–1421.Google Scholar
Segerdahl M, Ekblom A, Sandelin K, Wickman M, Sollevi A. Peroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics. Anesth Analg 1995; 80: 1145–1149.Google Scholar
Segerdahl M, Irestedt L, Sollevi A. Antinociceptive effects of perioperative adenosine infusion in abdominal hysterectomy. Acta Anaesthesiol Scand 1997; 41: 473–479.Google Scholar
Segerdahl M, Persson E, Ekblom A, Sollevi A. Intraoperative adenosine infusion reduces isoflurane concentrations during general anaesthesia for shoulder surgery. Acta Anaesthesiol Scand 1996; 40: 792–797.Google Scholar
Sollevi A, Belfrage M, Lundeberg T, Segerdahl M, Hansson P. Systemic adenosine infusion: a new treatment modality to alleviate neuropathic pain. Pain 1995; 61: 155–158.Google Scholar
Belfrage M, Sollevi A, Segerdahl M, Sjölund KF, Hansson P. Systemic adenosine infusion alleviates spontaneous and stimulus evoked pain in patients with peripheral neuropathic pain. Anesth Analg 1995; 81: 713–717.Google Scholar
Seitz PA, Riet M, Rush W, Merrell WJ. Adenosine decreases the minimum alveolar concentration of halothane in dogs. Anesthesiology 1990; 73: 990–994.Google Scholar
Segerdahl M, Ekblom A, Sollevi A. The influence of adenosine, ketamine and morphine on experimentally induced ischemic pain in healthy volunteers. Anesth Analg 1994; 79: 787–791.Google Scholar
Rane K, Segerdahl M, Goiny M, Sollevi A. Intrathecal adenosine administration: a phase 1 clinical safety in healthy volunteers with additional evaluation of its influence on sensory threshold and experimental pain. Anesthesiology 1998; 89: 1108–1115.Google Scholar
Rane K, Sollevi A, Segerdahl M. Intrathecal adenosine administration in abdominal hysterectomy lacks analgesic effect. Acta Anaesthesiol Scand 2000, 44: 868–872.Google Scholar
Belfrage M, Segerdahl M, Arnér S, Sollevi A. The safety and efficacy of intrathecal adenosine in patients with chronic neuropathic pain. Anesth Analg 1999; 89: 136–142.Google Scholar
Arnér S, Meyerson BA. Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain. Pain 1988; 33: 11–23.Google Scholar