Opioid actions on mammalian spinal neurons

Comparative study of hemodynamic effects of intrathecal bupivacaine with butorphanol in cardiac and non-cardiac patients

Background and Aims:

The synergism between intrathecal opioids and low dose local anesthetics makes it possible to achieve reliable spinal anesthesia (SA) with minimal hypotension. The study objective was to compare the hemodynamic effects of reduced dose of 0.5% intrathecal bupivacaine (2mL) with 25 μg butorphanol in cardiac vs non-cardiac patients.

Material and Methods:

We included sixty patients aged 30-80 years, undergoing infraumbilical surgeries in the study and compared thirty cardiac patients with mild to moderate reduction in left ventricular ejection fraction (LVEF) on 2D echocardiography (Group C) with 30 non-cardiac patients (Group NC) for similar types of surgery. Both the groups received 0.5% bupivacaine 2.0 ml with 25 μg butorphanol.

Results:

The spinal block characteristics were similar in both groups (P > 0.05). The blood pressure of the patients in the two groups was comparable till 80 min P > 0.05 after which Group NC had significant increase in blood pressure compared to Group C upto 95 min (P < 0.05). Similarly, heart rate was comparable until 90 min (P > 0.05) after which Group NC had significant increase in heart rate versus Group C upto 100 min (P < 0.05). Eight patients in group C and five patients in group NC showed hypotension. Bradycardia was seen in 4 patients in group C in comparison to only one patient in group NC.

Conclusion:

We can safely consider spinal anesthesia with 10 mg bupivacaine and 25μg butorphanol in cardiac patients with mild to moderately reduced ejection fraction presenting for infraumbilical non-cardiac surgeries with the advantage of intraoperative hemodynamic stability and adequate postoperative analgesia.

Comparison of intrathecal bupivacaine-fentanyl and bupivacaine-butorphanol mixtures for lower limb orthopedic procedures

CONTEXT

Intrathecal use of butorphanol is less explored in human subjects.

AIMS

To compare the safety and efficacy of anesthesia and analgesia of intrathecal bupivacaine-butorphanol mixture with intrathecal bupivacaine-fentanyl mixture.

SETTINGS AND DESIGN

Tertiary level, teaching hospital. Prospective, randomized, double-blind study.

MATERIALS AND METHODS

Eighty patients aged above 18 years, of ASA physical status 1 or 2, undergoing lower limb orthopedic surgeries were randomly allocated to two groups of 40 patients each. Patients in group A and group B received intrathecal 2.5 ml of hyperbaric bupivacaine (0.5%), with 25 μg of fentanyl and 25 μg of butorphanol, respectively.

STATISTICAL ANALYSIS USED

Fisher's exact test and Chi square tests.

RESULTS

The times required for onset of sensory and motor blockade were comparable among the two groups. Significantly slower block regression to S2 level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl (P=0.0230). A higher number of patients in group A requested for rescue analgesia during the postoperative period than in group B (9 versus 2; P=0.0238). The average times to first request for rescue analgesia were 308.6±14.9 minutes and 365.9±12.3 minutes in group A and B, respectively (P=0.0254).

CONCLUSIONS

Both 25 μg fentanyl and 25 μg butorphanol given intrathecally along with 12.5 mg of hyperbaric bupivacaine provide effective anesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture.

Immobility accompanies the antinociception mediated by the rostral ventromedial medulla of the rat

The rostral ventromedial medulla (RVM) is part of a descending pain modulatory system that runs from the periaqueductal gray (PAG) to the spinal cord. The objective of the present study was to determine whether the antinociception mediated by the RVM is associated with locomotor changes as has been reported for the PAG [42]. Kainate (4, 20, or 40 pmol), morphine (1, 5, or 10 microg), or saline (0.2 or 0. 5 microl) was injected into the RVM and locomotion and nociception assessed. Microinjections of kainate and morphine that produced antinociception almost invariably inhibited locomotor activity. In some rats this immobility consisted of no movements when placed in the center of the open field chamber. These data are consistent with the immobility and antinociception produced by activation of the ventrolateral PAG and indicate that the descending ventrolateral PAG/RVM system integrates a behavioral response of which antinociception is only one component.

Substance P and enkephalin immunoreactivities in axonal boutons presynaptic to physiologically identified dorsal horn neurons. An ultrastructural multiple-labelling study in the cat

A combination of intracellular electrophysiological recording and injection of horseradish peroxidase with ultrastructural immunocytochemistry was used to investigate the synaptic interplay between substance P- and enkephalin-immunoreactive axonal boutons and three types of functionally characterized dorsal horn neurons in the cat spinal cord. The dorsal horn neurons were classified as nociceptive specific, wide dynamic range and non-nociceptive based on their responses to innocuous and noxious stimuli. Most of the nociceptive neurons (either nociceptive specific or wide dynamic range) contained enkephalin immunoreactivity, but none of the non-nociceptive neurons were positive for enkephalin. Three types of immunoreactive boutons were found in contact with the functionally characterized dorsal horn neurons. These boutons were positive for either substance P, enkephalin, or substance P+enkephalin. Quantitative analysis revealed that the percentages of substance P-immunoreactive boutons apposed to the cell bodies, proximal dendrites and distal dendrites of nociceptive neurons were significantly higher than those of non-nociceptive neurons. Furthermore, the percentages of substance P+enkephalin-immunoreactive axonal boutons apposed to the distal dendrites of nociceptive neurons were significantly higher than those of non-nociceptive neurons and the percentages of enkephalin-immunoreactive boutons apposed to the cell bodies and proximal dendrites of nociceptive neurons were significantly higher than in non-nociceptive neurons. Finally, neither enkephalin-immunoreactive nor substance P+enkephalin-immunoreactive boutons were ever seen presynaptic to substance P-immunoreactive boutons. These results provide evidence of an anatomical substrate within the dorsal horn for the interaction of substance P-mediated with enkephalin-mediated mechanisms. The data support the idea that the modulation of nociceptive input in the dorsal horn by enkephalinergic neurons occurs mainly via a postsynaptic mechanism, and thus suggest that dorsal horn enkephalinergic neurons participate in a local inhibitory feedback loop in a distinct pathway from the previously postulated opioid-mediated depression of substance P release from primary afferent terminals.

The addition of bupivacaine to intrathecal sufentanil for labor analgesia

We designed a prospective, randomized, double-blind study to evaluate the efficacy of the combination of intrathecal sufentanil with a low dose of local anesthetic in an attempt to prolong analgesia in labor. Fifty-two patients received one of the following intrathecal study solutions: 2.5 mg of bupivacaine; 10 micrograms of sufentanil; or 2.5 mg of bupivacaine plus 10 micrograms of sufentanil. The mean duration of analgesia (min +/- SD) was significantly different among all three groups: 70 +/- 34 min for bupivacaine, 114 +/- 26 min for sufentanil, and 148 +/- 27 min for bupivacaine-sufentanil (P < 0.001). Visual analog scale (VAS) scores for pain were significantly higher in the bupivacaine group compared to both the sufentanil group and the bupivacaine-sufentanil group (P < 0.02), and were significantly higher in the sufentanil group compared to bupivacaine-sufentanil at 75 min postinjection and beyond (P < 0.02). Hypotension was not observed in the sufentanil group but occurred transiently in the other two groups (P = 0.09). There was no evidence of motor blockade, excessive somnolence, fetal heart rate (FHR) abnormalities, or postdural puncture headache (PDPH) in any of the patients. The addition of 2.5 mg of bupivacaine to 10 micrograms of intrathecal sufentanil significantly prolonged labor analgesia without adverse maternal or fetal effects.

Disinhibition of off-cells and antinociception produced by an opioid action within the rostral ventromedial medulla

Activation of neurons in the rostral ventral medulla, by electrical stimulation or microinjection of glutamate, produces antinociception. Microinjection of opioid compounds in this region also has an antinociceptive effect, indicating that opioids activate a medullary output neuron that exerts a net inhibitory effect on nociception. When given systemically in doses sufficient to produce antinociception, morphine produces distinct, opposing responses in two physiologically identifiable classes of rostral medullary neurons. "Off-cells" are activated, and have been proposed to inhibit nociceptive transmission. "On-cells" are invariably depressed, and may have a pro-nociceptive role. Although on-cell firing is also depressed by iontophoretically applied morphine, off-cells do not respond to morphine applied in this manner. The present study used local infusion of the mu-selective opioid peptide Tyr-D-Ala-Gly-MePhe-Gly-ol-enkephalin (DAMGO) within the rostral medulla to determine whether off-cells are activated by an opioid action within this region that is sufficient to produce a behaviorally measurable antinociception. Activity of on- and off-cells was recorded before and after local infusion of DAMGO noxious heat-evoked tail flick reflex was inhibited in 17 of 28 cases. On-cell firing was profoundly depressed, and this occurred irrespective of the antinociceptive effectiveness of the injection. Off-cells were activated following DAMGO microinjections, but only in experiments in which the tail flick reflex was inhibited. Both reflex inhibition and neuronal effects were reversed following systemic administration of naloxone. These observations thus confirm the role of the on-cell as the focus of direct opioid action within the rostral medulla, and strongly support the proposal that disinhibition of off-cells is central to the antinociception actions of opioids within this region.

Opioid action on spinal cord reflexes due to dorsolateral pontine tegmentum stimulation

Electrical stimulation of the dorsolateral pontine tegmentum (DLPT) produces phasic facilitatory and inhibitory actions on the lumbar spinal monosynaptic reflexes (MSRs) of both flexor and extensor muscle nerves in the decerebrate cat. Naloxone, an opioid receptor antagonist, given intravenously or intraspinally enhanced the DLPT-induced potentiation of MSRs in most of the reflexes studied. However, systemic naloxone had no significant effect on the unconditioned MSR of the spinal cord. Intraspinal microinjections of naloxone significantly attenuated the DLPT-induced inhibition of MSRs of both flexors and extensors, similar to the action of systemic injection of naloxone, indicating a direct opioid action at the spinal ventral horn level upon DLPT stimulation. Results of the present experiment further support the anatomical finding that there are pontospinal enkephalinergic pathways in the cat, and indicate that these descending pathways modulate spinal motor outflow.

Direct and indirect actions of morphine on medullary neurons that modulate nociception

The rostral ventromedial medulla is part of a neural network through which systemically administered morphine produces antinociception. Two physiologically characterized classes of presumed nociceptive modulating neurons that respond differentially to systemically administered morphine have been identified in this region: the firing of "on-cells" is depressed, whereas "off-cells" become continuously active. On-cells have been proposed to permit or facilitate, and off-cells to inhibit, nociceptive transmission. Because local application of morphine in the rostral ventromedial medulla itself is sufficient to produce antinociception, it is important to determine whether systemically administered morphine exerts its effects on neurons in this region by a direct action. Thus, activity of physiologically characterized neurons was studied before, during and after ionotophoretic administration of morphine. As with systemic administration, iontophoretic application of morphine depresses the activity of on-cells, an effect that is reversed by iontophoretic as well as by systemic administration of naloxone. In contrast, no reliable changes in the firing of off-cells are produced by iontophoretic administration of morphine. Cells of a third class, "neutral cells", are not affected by systemic morphine administration, nor do they respond to iontophoretic application of the drug. The present experiments demonstrate that direct opioid responsiveness in the rostral ventromedial medulla is limited to a single physiologically characterized class of presumed nociceptive modulatory neuron, the on-cell. This implies that the antinociceptive effect exerted by systemically administered morphine involves at least two components within the rostral ventromedial medulla: a direct inhibition of on-cells, and an indirect activation of off-cells. Each of these actions is likely to have a net hypoalgesic effect.

Nociceptive quality of the orbicularis oculi reflexes as evaluated by distinct opiate- and benzodiazepine-induced changes in man

The corneal reflex and the three components of the blink reflex (R1, R2, and R3) were recorded electromyographically in volunteers. The area of these responses was measured before and after administration of the narcotic-analgesic fentanyl (1.5 mg i.m.) and its antagonist naloxone, and after administration of the benzodiazepine diazepam (10 mg i.v.) and its antagonist flumazenil. Saline was given as a control placebo. The corneal reflex was 71% reduced by fentanyl, 43% by diazepam. R1 was 35% reduced and R2 was 60% reduced by diazepam. R3 was abolished by both drugs. Whereas the fentanyl-induced changes were completely reversed by naloxone, the diazepam-induced changes were only partly reversed by flumazenil. The corneal reflex appears to be a 'nociceptive' reflex under all points of view. Recording of the orbicularis oculi reflexes in man may be valuable in the evaluation of central-acting neurotropic drugs.

Central analgesic mechanisms: a review of opioid receptor physiopharmacology and related antinociceptive systems

Clinical applications of these principles, based on the increased understanding of central analgetic mechanisms, are already being undertaken. Not only does the use of intrathecal and epidural opioids have the potential to decrease pain and related morbidity after surgical procedures, but there is at least one study that demonstrates a significant reduction in both major morbidity and mortality in high-risk surgical patients in whom epidural anesthesia and analgesia were used. These principles are also useful for the management of patients undergoing cardiac surgery. Currently, high-dose narcotic anesthesia is the technique of choice for such patients because of the greater hemodynamic stability this anesthetic technique provides. However, breakthrough hypertension and tachycardia still occur, and prolonged postoperative ventilation is a necessary consequence due to the high doses of narcotics that are required. In one study of patients undergoing coronary artery surgery, preoperative administration of clonidine, 5 micrograms/kg, orally, was demonstrated to decrease fentanyl requirements by 45% (110 to 61 micrograms/kg) while producing a similar degree of hemodynamic stability as seen with high-dose fentanyl. Extubation times were not compared, but the significantly lower dosage of fentanyl in the clonidine-treated group would be expected to lead to an earlier extubation. Whether similar potentiation of narcotic effects would be seen with dexmedetomidine, which may also prevent narcotic-induced rigidity, has not been determined, but the clinical application of such synergistic and complementary agents is another consequence of the greater understanding of central analgesic mechanisms, and augurs well for the future.

Bombesin, neuromedin B and neuromedin C selectively depress superficial dorsal horn neurones in the cat spinal cord

The effects of bombesin and related peptides on functionally identified single dorsal horn neurones were studied using iontophoresis and extracellular recording in the anaesthetized and spinalized cat. Bombesin selectively depressed superficial dorsal horn neurones (in laminae I-III). The depression was of spontaneous activity as well as of synaptically elicited responses to natural stimulation of the cutaneous receptive field. Bombesin preferentially depressed neurones that responded to noxious stimulation of the cutaneous receptive field. Naloxone, bicuculline and caffeine failed to block the depression by bombesin, suggesting that the effect of the peptide may be direct and not through the indirect activation of an inhibitory system mediated by opioids, by gamma-aminobutyric acid (GABA) or by purines, respectively. Iontophoretic application of neuromedin B (n = 3) and neuromedin C (GRP-10) (n = 7) induced a similar depression to that observed with bombesin. These results provide physiological evidence that a bombesin-like peptide may play a role in the mediation or the modulation of sensory transmission in the superficial dorsal horn of the spinal cord.

Synaptic substrates for enkephalinergic and serotoninergic interactions with dental primary afferent terminals in trigeminal subnucleus interpolaris: an immunocytochemical study using peroxidase and colloidal gold

Pain processing in the trigeminal complex has been thought to reside primarily in the spinal subnucleus caudalis (Vc). However, trigeminal tractotomies eliminating primary afferent input to Vc and severance of secondary trigemino-thalamic fibers from Vc do not disturb pain perception from the central face and oral cavity. Furthermore, large numbers of neurons that are highly responsive to noxious stimuli and suppressed by inputs from the periaqueductal gray and raphe complex have been identified in subnuclei interpolaris (Vi) and oralis (Vo). Therefore, the purpose of this study was to assess the distribution and spatial arrangements of nociceptive modulatory transmitters with nociceptive afferents and trigemino-thalamic relay cells in the rostral portion of the spinal trigeminal nuclear complex. The dental pulp contains predominantly nociceptors that project to all three subdivisions of the trigeminal spinal complex. These projections were visualized by anterograde transganglionic transport of horseradish peroxidase or by degeneration following administration of toxic ricin to the pulp chambers. The spatial arrangements of dental primary afferents with enkephalinergic (ENK) and serotoninergic (5HT) inputs was then assessed by employing avidin-biotin peroxidase and protein-A colloidal gold double-labeling immunocytochemistry. Trigemino-thalamic relay cells were also labeled by retrograde transport of HRP after stereotaxic injections into the ventrobasal thalamus. ENK and 5HT immunoreactivity was found in the ventrolateral quadrant and lateral margin of Vi, together with the adjacent interstitial nucleus (IN). This activity extended from the caudal pole of Vi and the periobex region, where it was most dense, rostrally to a position approximately 2.9 mm from the Obex. Neither ENK nor 5HT immunoreactivity was observed in Vo. Primary dental afferents projected into the ventromedial quadrant of rostral Vi and were found in the ventrolateral quadrant and dorsal aspect of the subnucleus farther caudally. They appeared as simple boutons with single contacts or as larger, sometimes scalloped terminals that formed multiple contacts. Postsynaptic elements were usually small dendritic profiles, although relay cell somata rarely received primary afferent inputs. Many primary afferents entered areas of synaptic clustering and contacted enkephalinergic dendrites, some of which were also postsynaptic to serotoninergic synapses. Alternatively, primary afferents contacted unlabeled processes that were also postsynaptic to the enkephalinergic element to form a triad arrangement. The least common occurrence was axo-axonic contacts in which enkephalinergic synapses were presynaptic to primary afferents. Both enkephalinergic and serotoninergic synaptic categories displayed round vesicles and generally formed asymmetric junctions.(ABSTRACT TRUNCATED AT 400 WORDS)

Depression by morphine and the non-opioid analgesic agents, metamizol (dipyrone), lysine acetylsalicylate, and paracetamol, of activity in rat thalamus neurones evoked by electrical stimulation of nociceptive afferents

Pyrazolone and salicylic acid derivatives and the aniline derivative, paracetamol, are often classified as peripherally acting analgesic agents, while morphine is a centrally acting analgesic agent. Since indications exist that the non-opioid analgesic agents can also produce central effects, experiments were carried out on rats under urethane anaesthesia in which activity was recorded from single neurones in the dorsomedial part of the ventral nucleus (VDM) of the thalamus that was elicited by supramaximal electrical stimulation of nociceptive afferents in the sural nerve. In addition, activity was recorded in ascending axons of the spinal cord which was evoked by electrical stimulation of nociceptive afferents in the sural nerve. The substances studied were morphine, the pyrazolone derivatives, metamizol (dipyrone) and aminophenazone ('Pyramidon'), lysine acetylsalicylate, and paracetamol. All drugs were found to depress dose-dependently evoked activity in VDM neurones after intravenous (i.v.) injection. The ED50 of morphine in depressing evoked activity in VDM neurones is 0.05 mg/kg. Morphine also dose-dependently reduced activity in ascending axons of the spinal cord, the ED50 being 1.7 mg/kg. The ED50 of metamizol in depressing evoked activity in VDM neurones is 120 mg/kg, and that of aminophenazone is 22.7 mg/kg. The 2 ED50 values differ significantly. It has been found previously that metamizol increased nociceptive activity in some ascending axons and aminophenazone increased this activity in all ascending axons tested. The ED50 of lysine acetylsalicylate in depressing evoked activity in VDM neurones is 74 mg/kg. The drug did not reduce nociceptive activity in ascending axons of the spinal cord. The ED50 of paracetamol in depressing evoked activity in VDM neurones is 19.0 mg/kg. Paracetamol did not depress nociceptive activity in ascending axons of the spinal cord at a dose as high as 150 mg/kg administered by intraperitoneal injection. Naloxone (0.2 mg/kg i.v.) abolished the depressant effects of morphine but failed to reduce those of the non-opioid analgesic agents even at a high dose (1 mg/kg i.v.). Unlike morphine, the non-opioid analgesic agents did not completely block evoked activity in VDM neurones but only partially blocked their activation. The results suggest that the non-opioid analgesic agents tested can produce a central analgesic effect which, however, is weaker than that of morphine.

Pertussis toxin inhibits antinociception produced by intrathecal injection of morphine, noradrenaline and baclofen

The effect of intrathecal pretreatment with pertussis toxin on the spinal antinociceptive effect of morphine, noradrenaline and L-baclofen was examined in rats implanted with chronic indwelling cannulas. Pretreatment with 0.25-0.75 micrograms pertussis toxin for 2-7 days inhibited antinociception produced by intrathecal injection of all three agents in the tail flick test. Inhibition also occurred in the hot plate test, but was less pronounced than in the tail flick test. When doses of the three agents giving similar levels of antinociception were compared in a single group, the degree of inhibition of antinociception was comparable. Inhibition of the effect of noradrenaline was observed up to 14 days following pretreatment. The sensitivity of spinal antinociception to pertussis toxin suggests involvement of a guanine nucleotide regulatory protein in spinal actions of morphine, noradrenaline and L-baclofen. There is support in the literature for the additional involvement of adenylate cyclase in the action of morphine and noradrenaline but not of baclofen.

Effects of tramadol on motor and sensory responses of the spinal nociceptive system in the rat

The analgesic agent, tramadol, was tested on motor and sensory responses of the nociceptive system in rats. The tail-flick response to radiant heat was dose dependently depressed by tramadol (1-10 mg/kg i.p.), and the antinociceptive effect of the drug was reduced by naloxone in the same range of doses that antagonized the effect of morphine. Tramadol (100 micrograms) microinjected into the periaqueductal grey (PAG) prolonged the tail-flick latency and this effect was abolished by naloxone (0.2 mg/kg i.p.). Aminophylline (25 mg/kg i.p.) did not prevent the antinociceptive effect of tramadol (5 mg/kg i.p.). Tramadol (20 and 40 mg/kg injected i.v.; 100 and 200 micrograms injected intrathecally (i.t.); 100 micrograms injected into the PAG) depressed both the spontaneous activity in ascending axons and their activity due to stimulation of afferent C fibres and co-activation from afferent A delta fibres in the sural nerve. Naloxone injected i.v. at a dose (0.2 mg/kg) that had proven fully effective against the effects of morphine antagonized only the effect on spontaneous activity caused by i.v. injection of tramadol. A high dose of naloxone (1 mg/kg i.v.) not only abolished the depression of spontaneous activity caused by an i.t. injection of tramadol (200 micrograms) but also significantly reduced (but did not abolish) the activity in ascending axons evoked from afferent C fibres while the depression of co-activation from afferent A delta fibres remained unchanged. Aminophylline (50 micrograms i.t.) failed to abolish the depression by tramadol of ascending nociceptive activity. The activity elicited in ascending axons by stimulation of afferent A beta fibres was not changed by i.t. injection of tramadol (200 micrograms), which was evidence that the antinociceptive effect of tramadol is not due to a local anaesthetic action. It is concluded that tramadol produces its antinociceptive and analgesic effects through spinal and supraspinal sites of action. Since the effects of tramadol and morphine differ in some respects, it must be assumed that they are due to binding to different opiate receptors or that some of the effects of tramadol are not mediated by opiate receptors alone.

Central analgesic effect of paracetamol manifested by depression of nociceptive activity in thalamic neurones of the rat

To study the question whether or not paracetamol produces a central analgesic effect, experiments were carried out on rats under urethane anaesthesia in which activity was elicited by supramaximal electrical stimulation of nociceptive afferents in the sural nerve and recorded from single neurones in the dorsomedial part of the ventral nucleus (VDM) of the thalamus. Paracetamol administered by intraperitoneal (i.p.) injection at doses of 50, 100 and 150 mg/kg reduced nociceptive evoked but not spontaneous activity. The amount of depression caused by the 3 doses and the time course of their effects was practically the same. suggesting that paracetamol is not capable to abolish nociceptive evoked activity in the thalamus but causes a maximum depression of the activity amounting to not more than about 60% of the controls. An intravenous (i.v.) injection of naloxone (1 mg/kg) did not diminish paracetamol-induced depression. The results present evidence for a central analgesic effect of paracetamol that is independent of endogenous opioids.

Mutual potentiation of antinociceptive effects of morphine and clonidine on motor and sensory responses in rat spinal cord

Clonidine and morphine depress nociceptive reflex responses when given alone; when given in combination, the effect of each is potentiated by the other. The present study was designed to test if activity in ascending axons evoked by electrical stimulation of afferent C-fibers in the sural nerve of the rat also exhibits potentiation of the depressant effects of clonidine and morphine when both drugs are administered in combination by intrathecal (i.t.) injection to the lumbar spinal cord. For comparison, experiments were also carried out on the tail-flick response in rats. The results show that clonidine produced a dose-dependent inhibition of the tail-flick response (Ed50 20 micrograms); a combination of ineffective doses of clonidine (0.3 microgram) and morphine (2 micrograms) significantly inhibited the tail-flick response; clonidine (35 micrograms) reduced spontaneous, C-fiber-evoked and, due to co-activation, A delta-fibre-evoked activity in ascending axons; and clonidine at a threshold (0.3 microgram) or higher (3 micrograms) dose administered together with morphine at a dose (2 micrograms) that caused only a moderate inhibition produced a supra-additive effect in significantly depressing spontaneous. A delta- and C-fiber-evoked ascending activity. The dose-response curve of depression by morphine alone of C-fiber-evoked activity (ED50 8 micrograms) is significantly shifted by clonidine to the left (ED50 0.9 microgram). Naloxone (0.2 mg/kg) injected intravenously did not affect the inhibition of ascending activity caused by clonidine at the highest dose (35 micrograms), but it reduced the depressant effect of combined i.t. administration of clonidine and morphine. The potentiation of the antinociceptive effects of clonidine and morphine given in combination are possibly due to actions of the two drugs at different sites between the nociceptive afferents and the neurons sending their axons to the brain.

Responses of rat dorsal horn neurons to natural stimulation and to iontophoretically applied norepinephrine

Extracellular recordings were obtained of 177 neurons throughout the lumbar spinal dorsal horn of urethane- or halothane-anesthetized rats. These neurons all responded to iontophoretically applied L-glutamate and their responses to natural stimulation of the ipsilateral hindlimb were characterized. Iontophoretically applied norepinephrine was tested on 94 of these neurons. Fifty-one neurons were inhibited and 22 were excited. Norepinephrine produced a biphasic inhibitory/excitatory effect on nine neurons. Norepinephrine was exclusively inhibitory on superficial dorsal horn neurons that responded only to innocuous brush and touch and on neurons in the nucleus proprius that responded to brush, touch, and noxious skin pinch. Norepinephrine excited some superficial brush/touch/pinch neurons and produced short inhibitions that were followed by prolonged excitations of some nucleus proprius neurons that responded only to noxious skin pinch. Neurons in the base of the dorsal horn that responded to low-threshold proprioceptive stimulation were excited by norepinephrine. Both the inhibitory and excitatory effects of norepinephrine were stereoselective, but they were not blocked by receptor subtype-selective antagonists. Desensitization to norepinephrine occurred for 30% of the neurons. This study demonstrates that the inhibitory effects of norepinephrine on rat dorsal horn neurons are not restricted to neurons that are responsive to noxious stimuli and that some of these neurons are primarily excited by norepinephrine. The excitatory effects of norepinephrine on low-threshold proprioceptive neurons may contribute to norepinephrine's known enhancement of spinal flexor reflex activity.

Activation of inhibition from the periaqueductal grey matter mediates central analgesic effect of metamizol (dipyrone)

The pyrazolone derivative, metamizol (dipyrone), possesses analgesic, antipyretic, anti-inflammatory and spasmolytic properties. It is often classified as peripherally acting. To test the possibility that a central action of the drug contributes to its antinociceptive and analgesic effects, experiments were carried out in which the tail-flick response to radiant heat, flexor reflex activity in the tibialis anterior muscle and activity in ascending spinal axons evoked by stimulation of afferent C fibres in the sural nerve, and activity of neurones in the periaqueductal grey matter and the substantia nigra were assessed in rats. Metamizol administered by intraperitoneal (i.p.; 10, 20 and 40 mg/kg) or intrathecal (i.t.; 50 to 400 micrograms) injection to intact rats dose-dependently prolonged the tail-flick latency. Administration by i.t. injection to spinal rats was without effect. Intravenous (i.v.) injection of metamizol (140 mg/kg) reduced flexor reflex activity in intact animals, while an i.t. injection to spinal rats was ineffective at a low dose (100 micrograms) or enhanced the reflex activity at a higher dose (400 micrograms). Activity in ascending axons responding to afferent C fibre stimulation was mostly depressed by i.t. injection of metamizol (40, 80 and 140 mg/kg) in rats with an intact spinal cord. Ascending activity was increased by i.t. injection of the drug (100 and 200 micrograms) to spinal rats. Metamizol (140 mg/kg) i.v. increased the activity of neurones in the PAG and reduced that of neurones in the substantia nigra. Metamizol administered by microinjection into the PAG prolonged the tail-flick latency (15-100 micrograms) and depressed C fibre-evoked activity in ascending axons (100 micrograms). The results suggest that a central action is involved in the analgesic effect of metamizol and that this central action manifests itself by an activation of inhibition originating in the PAG.

Interaction of pentobarbital and morphine in the tail-flick test performed on rats: synergism at the spinal and antagonism at the supraspinal level

The dose-dependence of the effects and interaction of pentobarbital and morphine administered by intrathecal (i.t.) and intraperitoneal (i.p.) injection was determined in experiments performed on the tail-flick response to radiant heat applied to the tail of rats. I.t. injection of pentobarbital and morphine, and i.p. injection of morphine depressed the tail-flick response, while i.p. injection of pentobarbital facilitated it. The effects caused by i.t. injection of the two drugs depended on the intensity of noxious stimulation. When pentobarbital and morphine were administered in combination by i.t. injection, they potentiated each other's effect. After i.p. injection of pentobarbital and morphine the facilitatory effect of pentobarbital was abolished and the antinociceptive effect of morphine was enhanced. The results reveal a synergism of the actions of pentobarbital and morphine at the spinal level and an antagonism at the supraspinal level which is probably of the functional type.

Tonic descending inhibition affects intensity coding of nociceptive responses of spinal dorsal horn neurones in the cat

The supraspinal inhibitory control of lumbar spinal dorsal horn neurones was investigated in N2O-anaesthetized cats by reversibly blocking conduction in the spinal cord. Dorsal horn neurones selected for this study had convergent input from myelinated (A-) and unmyelinated (C-) fibres in the posterior tibial and/or superficial peroneal nerves of the hind limb. Virtually all of them could also be excited by noxious heating of the skin of the footpad region and by low intensity mechanical stimulation of the foot. Variation of the temperature of noxious radiant skin heating (40-56 degrees C, 10 sec in duration) resulted in graded responses of the neurones. The stimulus-response functions (SRF) were monotonic; in the majority of 32 cases they were linear. Neurones could be classified according to their maximum discharge frequency in response to skin heating into 22 weakly sensitive units (responses below 100 Hz at 50 degrees C) and 10 highly sensitive units (above 100 Hz). Responses outlasted the period of skin heating by seconds to minutes. A reversible conduction block of spinal axons by cooling a 15 mm cord segment (L1) with a thermode at 0 degrees C affected the responsiveness of the dorsal horn neurones in 12 of 15 cases. The maximum discharge frequency to a certain temperature of skin heating was increased during the spinal block. The duration of heat-evoked discharges was either not changed or increased during the spinal block. The SRF were reversibly displaced during the spinal blockade to higher discharge frequencies and lower threshold temperatures of skin heating. In 8 of 12 cases the change in the SRF was a nearly parallel shift, whereas in 4 units the increase of responsiveness had a complex effect upon the SRF. The decrease in the threshold to skin heating ranged up to 4.5 degrees C; the mean decrease was 2 degrees C. It is confirmed that in anaesthetized cats, nociceptive spinal neurones are subject to a tonically active descending inhibition, which is interrupted by local spinal cooling. The effect of the spinal block on the SRF of the neurones suggests that this tonic inhibition is similar to that produced by electrical stimulation in the lateral reticular formation of the brain-stem.