Analgesic Efficacy of I.M. Alfentanil

Arendt-Nielsen, Lars; Øberg, B.; Bjerring, Peter

doi:10.1093/bja/65.2.164

Cited by 30 publications

(14 citation statements)

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“…significantly changed the reaction to laser heat pain tolerance, cold pain tolerance, mechanical pain tolerance and electrical stimulation, when similar methods were used as in the present study. Arendt-Nielsen, Øberg and Bjerring [18] used brief argon laser pulses covering a small area to determine the analgesic effect of alfentanil. The same method has also been used to show an analgesic effect of weak analgesics [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Petersen-Felix

Arendt‐Nielsen

Bak

et al. 1996

European Journal of Anaesthesiology

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SummaryThe analgesic effect of subanaesthetic concentrations of ether, trichloroethylene, methoxyflurane and halothane has been investigated previously using either clinical assessment or pain threshold measurements, but with conflicting results. The purpose of the present study was to evaluate the analgesic effect of isoflurane using experimental pain models. We studied 12 healthy volunteers at three randomly chosen subanaesthetic isoflurane concentrations: low (0.10-0.14 vol %), middle (0.16-0.20 vol %) and high (0.22-0.26 vol %). We used thermal pain detection and pain tolerance thresholds to argon laser stimulation, pressure pain detection and pain tolerance thresholds, immersion of the hand in ice water, and the nociceptive reflex to single and repeated (temporal summation) electrical stimulations, as experimental models to assess analgesia. There were no significant changes in the response to heat, cold or mechanical pressure at any of the subanaesthetic concentrations of isoflurane used. The nociceptive reflex thresholds to single stimulations, but not the thresholds for repeated stimulations, were significantly increased in all three isoflurane groups compared with baseline values. The difference between the different isoflurane concentrations was not statistically significant. In experimental pain models, subanaesthetic isoflurane concentrations have little or no analgesic potency. (Br. J. Anaesth. 1995; 75: 55-60)

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Section: Discussionmentioning

confidence: 99%

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Petersen-Felix

Arendt‐Nielsen

Bak

et al. 1996

European Journal of Anaesthesiology

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“…Similarly, alfentanil 30 μg kg −1 reduced the P2 peak at approximately 300 ms of the laser evoked potentials and increased thresholds to painful stimulation, but not the threshold to sensory stimulation . To document an opioid specific effect it was shown that naloxone restored the EP amplitudes and pain thresholds . Alfentanil also reduced EP amplitude and pain rating to tooth pulp stimulation and there was a dose dependent decrease in amplitudes to laser stimulation of the skin .…”

Section: Opioidsmentioning

confidence: 99%

Electroencephalography and analgesics

Malver

Brokjær

Staahl

et al. 2013

Brit J Clinical Pharma

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To assess centrally mediated analgesic mechanisms in clinical trials with pain patients, objective standardized methods such as electroencephalography (EEG) has many advantages. The aim of this review is to provide the reader with an overview of present findings in analgesics assessed with spontaneous EEG and evoked brain potentials (EPs) in humans. Furthermore, EEG methodologies will be discussed with respect to translation from animals to humans and future perspectives in predicting analgesic efficacy. We searched PubMed with MeSH terms 'analgesics' , 'electroencephalography' and 'evoked potentials' for relevant articles. Combined with a search in their reference lists 15 articles on spontaneous EEG and 55 papers on EPs were identified. Overall, opioids produced increased activity in the delta band in the spontaneous EEG, but increases in higher frequency bands were also seen. The EP amplitudes decreased in the majority of studies. Anticonvulsants used as analgesics showed inconsistent results. The N-methyl-D-aspartate receptor antagonist ketamine showed an increase in the theta band in spontaneous EEG and decreases in EP amplitudes. Tricyclic antidepressants increased the activity in the delta, theta and beta bands in the spontaneous EEG while EPs were inconsistently affected. Weak analgesics were mainly investigated with EPs and a decrease in amplitudes was generally observed. This review reveals that both spontaneous EEG and EPs are widely used as biomarkers for analgesic drug effects. Methodological differences are common and a more uniform approach will further enhance the value of such biomarkers for drug development and prediction of treatment response in individual patients.

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“…Although we endeavored to statistically control for group differences on mean age, race and neuroticism (Table, Supplemental Digital Content 1 which illustrates exploratory multivariable analyses), the small sample size limits confidence in our ability to minimize confounds. Second, there was a variable rate of absorption between participants receiving IM alfentanil administration, a known property of this route of administration 25 . The total absorbed dose may not have been high enough to induce OIH, especially as no episodes of vomiting occurred amongst the alfentanil group, a common side effect at moderately high alfentanil doses 56 .…”

Section: Discussionmentioning

confidence: 99%

“…Alfentanil was selected as the opioid agonist for its short onset of action, relatively short half-life, and favorable safety profile in previous IM experiments with healthy volunteers 25–27 . 15 mcg/kg was the dose chosen as it has been demonstrated to produce analgesia in clinical settings 26, 27 .…”

Section: Methodsmentioning

confidence: 99%

The Effect of Repeated Intramuscular Alfentanil Injections on Experimental Pain and Abuse Liability Indices in Healthy Males

Tompkins

Smith

Bigelow

et al. 2014

The Clinical Journal of Pain

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Objective Opioid-induced hyperalgesia (OIH), increased sensitivity to noxious stimuli following repeated opioid exposures, has been demonstrated in pre-clinical studies. However, there is no accepted, prospective model of OIH following repeated opioid exposures currently available in humans. This study assessed a potential prospective OIH model. Methods Double-blind intramuscular (IM) injections of a short-acting opioid, (alfentanil 15 mcg/kg; N=8) were compared to active placebo (diphenhydramine 25 mg; N=3) on cold and pressure pain testing and standard abuse liability measures in eight 10-hour sessions (1 injection/session) over 4–5 weeks in healthy pain-free males. Decreases from session baseline pain threshold (PThr) and tolerance (PTol) were calculated to represent hyperalgesia, and were assessed both within and across sessions. Results Mean decreases in cold PTol were seen in the alfentanil group at 180 minutes (−3.8 seconds, +/−26.5) and 480 minutes (−1.63 seconds, +/−31.5) after drug administration. There was a trend for differences between conditions on cold PThr hyperalgesia but not for pressure PThr. Alfentanil participants had greater mean ratings on LIKING and HIGH visual analog scales at peak effects (30 minutes), but these scores did not change across sessions. Discussion Repeated alfentanil exposures over 4–5 weeks resulted in within session decreases in cold pain tolerance from baseline but these differences were not substantially different from diphenhydramine controls. The results did not support the phenomenon of OIH in this model, although definitive conclusions regarding the existence of OIH in humans likely requires a larger sample size or an alternative model.

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Analgesic Efficacy of I.M. Alfentanil

Cited by 30 publications

References 0 publications

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Electroencephalography and analgesics

The Effect of Repeated Intramuscular Alfentanil Injections on Experimental Pain and Abuse Liability Indices in Healthy Males

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