Reproducibility of different laser Doppler fluximetry parameters of postocclusive reactive hyperemia in human forearm skin.

INTRODUCTION: Postocclusive reactive hyperemia in forearm skin is a commonly used model for studying microvascular reactivity function, particularly in the assessment of vascular effect of topically applied pharmacological substances. In this study, we investigated the reproducibility of several different laser-Doppler-derived parameters in the measurement of postocclusive reactive hyperemia at forearm skin in healthy subjects. METHODS: Eighteen young healthy male volunteers were recruited and studied in a supine position while fasted. Forearm blood flow was occluded at suprasystolic pressure for 3 min. Microvascular perfusion was measured continuously using laser Doppler fluximetry. Parameters studied were maximum increase in hyperemia perfusion (PORHmax), time-to-peak (Tp), amplitude of peak perfusion (PORHpeak), percentage of hyperemic response (PORH%) and mean velocity of the hyperemia increase (PORHmax/Tp). Measurement was performed twice within each study day for 2 study days. Coefficient of variation and intraclass correlation coefficient (ICC; with 95% confidence interval) were calculated for each parameter. An ICC value above 0.75 was interpreted as "excellent reproducibility". RESULTS: ICC analysis showed that all studied parameters, except for PORH%, demonstrated excellent reproducibility for both within- and between-day measurements. Satisfactory intraday and interday coefficients of variation (<10%) were also obtained for these parameters. CONCLUSION: Laser-Doppler-derived PORHmax, Tp, PORHpeak and PORHmax/Tp were highly reproducible parameters for measuring microvascular reactivity during reactive hyperemia, with PORHmax shown as the most reproducible index. PORH% is, however, less reproducible. These findings have implications for the use of laser Doppler fluximetry coupled with 3-min-occlusion PORHmax as a useful and reliable noninvasive clinical measurement index of microvascular function.

Postherpetic neuralgia: topical lidocaine is effective in nociceptor-deprived skin.

OBJECTIVES: Topical lidocaine is effective in postherpetic neuralgia (PHN). The aim of the present investigation was to classify patients according to their predominant peripheral nociceptor function and to compare these data with the results of a controlled study using dermal lidocaine patch. METHODS: Within the skin area of maximal pain QST (thermotest) and QCART (histamine iontophoresis and laser Doppler flowmetry) were performed prospectively in 18 PHN patients. A controlled study using cutaneous lidocaine (lidocaine 5% patch, IBSA) followed. RESULTS: Six patients (group I, sensitised nociceptors) had no sensory loss. Heat pain thresholds were equal or lower than on the contralateral side. Histamine-induced flare and axon reflex vasodilatation were not different on both sides. Histamine evoked pain increased. In 12 patients (group II, nociceptor impairment) heat pain thresholds were higher than contralateral. Histamine-induced flare was impaired or abolished. Histamine did not induce any sensation. Lidocaine was efficacious in the entire group of patients. Subgroup analysis revealed that patients with impairment of nociceptor function had significantly greater pain reduction under lidocaine vs placebo. Patients with preserved and sensitised nociceptors demonstrated no significant pain relief. CONCLUSIONS: PHN patients differ concerning their cutaneous nociceptor function: In the group I pain is caused by pathologically sensitised nociceptors. In subset II there is a loss of function of cutaneous C-nociceptors within the allodynic skin. Patients responded well to topical lidocaine even if the skin was completely deprived of nociceptors. Different underlying mechanisms of lidocaine action in nociceptor-deprived skin are discussed.