Analgesic effect of adenosine on ischaemic pain in human volunteers

Abstract

This study was designed to measure ischaemic pain during and after infusion of adenosine. In a double-blind, placebo-controlled, crossover study, eight ASA 1 male volunteers received infusion of adenosine 100 micrograms kg-1 min-1 or placebo for 10 min. This was repeated 1 week later with the alternate infusion. Pain measurements were made during tourniquet-induced ischaemia in an exercising arm before infusion, during infusion and for 24 h afterwards. Pain was reduced significantly in the adenosine group compared with the saline group during infusion (median difference 20.8; 95% confidence interval 2.0-40). There was no significant difference in pain after infusion and there were no significant changes in cardiovascular variables. During infusion of adenosine, transient mild chest discomfort, shortness of breath and facial flushing occurred. We conclude that adenosine had measurable effects on ischaemic pain which were not sustained after discontinuation of infusion.

Clinical application of adenosine and ATP for pain control

“…Infusion of adenosine at 70 mg·kg -1 ·min -1 reduced C fibermediated ischemic pain induced in the arm by the submaximum effort tourniquet technique, which resembled clinical postoperative deep somatic pain [36]. Another group of investigators also showed measurable analgesic effects of adenosine infusion at 100 mg· kg -1 ·min -1 for 10 min on pain during tourniquet-induced ischemia in an exercising arm [37]. In a study on patients with known effort-induced ischemic heart disease, lowdose adenosine (35 mg·kg -1 ·min -1 ) reduced effortinduced angina by 45%, although it did not affect the heart rate/blood pressure product or ECG signs of myocardial ischemia, suggesting an antinociceptive effect on visceral pain as well [34].…”

Adenosine Receptor Agonists Modulate Visceral Hyperalgesia in the Rat

“…11,12 Clinically adenosine became a new candidate of analgesic for the treatment of patients with neuropathic pain. [13][14][15] This study was performed in visceral hypersensitivity model and the results revealed adenosine and its analogues can have important role in the treatment of functional gastrointestinal disorders. Furthermore, there is an evidence of pain relief by adenosine in patients with noncardiac chest pain.…”

Continuous peripheral nerve block for ambulatory surgery

“…[5][6][7][8][9] Two placebo-controlled studies have addressed the effect of systemic adenosine on secondary hyperalgesia induced by experimental pain models. In the first study, IV adenosine 50 g/kg/min reduced mustard oil-induced von Frey and brush allodynia in 6 volunteers.…”

“…20 In 2 studies of ischemic experimental pain, administration of IV adenosine 70 g/kg/min had an analgesic effect. 5,6 Three placebo-controlled studies have investigated the analgesic effects of intraoperative IV adenosine infusion (80 g/kg/min) during breast surgery, 10 shoulder joint surgery, 21 and abdominal hysterectomy, 11 respectively. Intraoperative isoflurane concentrations were significantly reduced with adenosine in all studies.…”

“…1 In healthy human volunteers, systemic bolus administration (ranging from 10.6 mg to 37.1 mg adenosine) results in angina-like pain. 4 In contrast, systemic administration of doses under 80 g/kg/ min have been shown to have antinociceptive and antihyperalgesic effect in healthy volunteers, [5][6][7][8][9] surgical patients, [10][11][12] and in patients with chronic pain. 13,14 However , as most of these studies have included only a few volunteers or patients, and because the results are not consistent, there is a need for large-scale, randomized, placebo-controlled studies to clarify the role of adenosine in the treatment of various pain states, including acute nociceptive pain and pain involving central sensitization. Human experimental pain models can simulate clinical pain conditions.…”