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1Department of Physiology and Experimental Pathophysiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany; and 2Department of Anesthesiology and Intensive Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany
Submitted 18 December 2002; accepted in final form 29 January 2003
The contribution for the development of secondary mechanical hyperalgesia by peripheral mechanisms has not been fully elucidated. We have reevaluated the effects of local anesthetics on electrically evoked flare reaction and mechanical hyperalgesia in human skin. We applied 2% lidocaine via intradermal microdialysis fibers at a length of 10 cm for 110 min to the volar forearm to establish a narrow and stable "anesthetic strip." After 60 min of lidocaine perfusion, transdermal electrical stimulation (1 Hz, 50 mA) was applied at a distance of 1 cm from the microdialysis fibers for 30 min. The areas of allodynia and punctate hyperalgesia were marked at the end of the stimulation period. The flare reaction was assessed by laser Doppler scanner and infrared thermography. Total protein content of the dialysate collected at the stimulating electrode was measured photometrically. We found no increase in protein content during electrical stimulation. Flare area (12.4 ± 2.3 vs. 3.5 ± 1.2 cm2) and intensity (426 ± 24 vs. 257 ± 21 PU) were significantly reduced beyond the lidocaine strip. The mean temperature increase in the area beyond the lidocaine strip was significantly reduced (1.1 ± 0.1 vs. 0.2 ± 0.1°C) and did not differ from control areas. In contrast, allodynia (7.4 ± 0.7 and 8.6 ± 0.9 cm) and punctate hyperalgesia (7.6 ± 0.7 and 8.6 ± 0.9 cm) developed symmetrically on both sides of the anesthetic strip. Allodynia subsided 4 min after the end of the electrical stimulation. We conclude that the development of allodynia and punctate hyperalgesia in human skin is centrally mediated, whereas the axon reflex vasodilation is of peripheral origin.
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