Somatosensory Evoked Potentials: Objective Measures of Antinociception in the Anesthetized Patient?

  • E. Kochs
Conference paper


The most critical problems in pain research and clinical practice are the quantitation of nociception and the subjective experience of pain. From a physiologic point of view, pain is a consequence of the activation of nociceptive afferents and neural activity induced by noxious stimuli. The increased nociceptive signal transmission induces changes in brain electrical activity which may be assessed by physiologic measures. One of these neurophysiologic measures is the somatosensory evoked potential (SEP). SEPs reflect changes in brain electrical activity induced by electrical, mechanical, thermal, chemical, or tactile stimulation of peripheral neves. SEPs represent the activities of a rather large number of subcortical and cortical neural generators and are widely used as objective measures of sensory function [56]. The evoked cerebral potential reflects activation of specific afferent sensory systems. However, the evoked response is not specific for a unique stimulus modality. The early SEP components show peak latencies of less than 80 ms. They are separated into early farfield potentials with origins in subcortical structures (e.g., spinal cord, brain stem, thalamus) and early nearfield potentials generated by stimulus-induced summated postsynaptic activity of cortical neurons [22] (Fig. 1). Late SEP components with peak latencies of 80 ms or more may coincide with cognitive signal recognition or magnitude estimation [3, 4, 11, 12, 14–17]. They can best be recorded over the vertex. Both early and late SEPs reflect activity in large myelinated peripheral nerve fibers which activate the dorsal column [23].


Somatosensory Evoke Potential Narcotic Analgesic Noxious Stimulation Late SEPs Brain Electrical Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arendt-Nielsen L, Oberg B, Bjerring P (1990) Laser-induced pain for quantitative comparison of intravenous regional anesthesia using saline, morphine, lidocaine, or prilocaine. Reg Anaesth 15: 186–193Google Scholar
  2. 2.
    Baines DB, Whittle IR, Chaseling RW, Overton JH, Johnson IH (1985) Effect of halothane on spinal somatosensory evoked potentials in sheep. Br J Anaesth 57: 869–899CrossRefGoogle Scholar
  3. 3.
    Bromm B (1984) The evoked cerebral potential and pain. In: Fields HL, Dubner R, Cervero F (eds) Pain measurement in man. Elsevier, Amsterdam, pp 397–408Google Scholar
  4. 4.
    Bromm B (1994) Central evoked brain potential as overall control of afferent systems. In: Schulte am Esch J, Kochs E (eds) Central nervous system monitoring. Springer, Berlin Heidelberg New York, pp 115–126Google Scholar
  5. 5.
    Bromm B, Meier W (1984) The intracutaneous stimulus: a new pain model for algesimetric studies. Meth Find Exp Clin Pharmacol 6: 405–410Google Scholar
  6. 6.
    Bromm B, Scharein E (1982) Principal component analysis of pain-related cerebral potentials to mechanical and electrical stimulation in man. Electroencephalogr Clin Neurophysiol 53: 305–329Google Scholar
  7. 7.
    Bromm B, Treede RD (1991) Laser-evoked cerebral potentials in the assessment of cutaneous pain sensitivity in normal subjects and patients. Rev Neurol 147: 625–643PubMedGoogle Scholar
  8. 8.
    Bromm B, Meier W, Scharein E (1983) Antagonism between tilidine and naloxone on cerebral potentials and pain ratings in man. Eur J Pharmacol 87: 431–439PubMedCrossRefGoogle Scholar
  9. 9.
    Bromm B, Ganzel R, Herrmann WM, Meier W, Scharein E (1986) Pentazocine and flupirtine effects on spontaneous and evoked EEG activity. Neuropsychobiology 16: 152–156PubMedCrossRefGoogle Scholar
  10. 10.
    Bromm B, Rundshagen I, Scharein E (1991) Central analgesic effects of acetylsalicylic acid in healthy man. Arzneim Forsch Drug Res 11: 1123–1129Google Scholar
  11. 11.
    Buchsbaum MS, Davis GC, Naber D, Pickar D (1983) Pain enhanced naloxone-induced hyperalgesia in humans as assessed by somatosensory-evoked potentials. Psychopharmacology 79: 99–103PubMedCrossRefGoogle Scholar
  12. 12.
    Carmon D, Dotan Y, Same Y (1978) Correlation of subjective pain experience with cerebral evoked responses to noxious thermal stimulations. Exp Brain Res 33: 445–453PubMedCrossRefGoogle Scholar
  13. 13.
    Carmon A, Friedman Y, Coger R, Kenton B (1980) Single trial analysis of evoked potentials to noxious thermal stimulation in man. Pain 8: 21–32PubMedCrossRefGoogle Scholar
  14. 14.
    Chapman CR, Benedetti C (1979) Nitrous oxide effects on cerebral evoked potentials to pain: partial reversal with a narcotic analgesic. Anesthesiology 51: 135–138PubMedCrossRefGoogle Scholar
  15. 15.
    Chapman CR, Chen ACN, Colpitts YM, Martin RW (1981) Sensory decision theory describes evoked potentials in pain discrimination. Psychophysiology 18: 114–120PubMedCrossRefGoogle Scholar
  16. 16.
    Chapman CR, Colpitts YM, Benedetti C, Butler S (1982) Event-related potential correlates of analgesia; comparison of fentanyl, acupuncture and nitrous oxide. Pain 14: 327–337PubMedCrossRefGoogle Scholar
  17. 17.
    Chatrian GE, Canfield RC, Knauss TA, Lettich E (1975) Cerebral responses to electrical tooth pulp stimulation. Neurology (Minneapolis) 25: 745–757Google Scholar
  18. 18.
    Chen ACN, Chapman CR (1980) Aspirin analgesia evaluated by event-related potentials in man: possible central action in brain. Exp Brain Res 39: 359–364PubMedCrossRefGoogle Scholar
  19. 19.
    Chiappa KH, Choi SK, Young RRG (1980) Short-latency somatosensory evoked potentials following median nerve stimulation in patients with neurological lesions. In: Desmedt JE (ed) Clinical uses of cerebral, brainstem and spinal somatosensory evoked potentials, vol 7. Prog Clin Neurophysiol, Karger, Basel, pp 264–281Google Scholar
  20. 20.
    Chen ACN, Treede RD, Bromm B (1986) Modulation of pain-evoked cerebral potentials by concurrent subacute pain. In: Bromm B (ed) Pain measurement in man. Neurophysiologies correlates of pain. Elsevier, Amsterdam, pp 301–310Google Scholar
  21. 21.
    Chudler EH, Dong WK (1983) The assessment of pain by cerebral evoked potentials. Pain 16: 221–244PubMedCrossRefGoogle Scholar
  22. 22.
    Creutzfeldt O (1983) Cortex cerebri. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  23. 23.
    Desmedt JE (1989) Somatosensory evoked potentials in neuromonitoring. In: Desmedt JE (ed) Neuromonitoring in surgery. Elsevier, Amsterdam, pp 1–20Google Scholar
  24. 24.
    Drummod JC, Todd MM, Hoi Sang U (1985) The effect of high-dose sodium thiopental on brain stem auditory and median nerve somatosensory evoked responses in humans. Anesthesiology 63: 249–254CrossRefGoogle Scholar
  25. 25.
    Freye E, Hartung Schenk GK (1989) Somatosensory-evoked potentials during block of surgical stimulation with propofol. Br J Anaesth 63: 357–359PubMedCrossRefGoogle Scholar
  26. 26.
    Hill HF, Chapman CR, Saeger LS, Bjurstrom R, Walter MH, Schoene RB, Kippes M (1990) Steady-state infusions of opioids in humans. II. Concentration-effect relationships and therapeutic margins. Pain 43: 69–79Google Scholar
  27. 27.
    Hillyard SA (1978) Sensation, perception and attention: analysis using ERPs. In: Callaway E, Tueting P, Koslow SH (eds) Event-related brain potentials in man. Academic, London, pp 223–321Google Scholar
  28. 28.
    Handwerker HO, Kobal G (1993) Psychophysiology of experimentally induced pain. Physiol Rev 73: 639–671PubMedCrossRefGoogle Scholar
  29. 29.
    Hume AL, Cant BR (1978) Conduction time in central somatosensory pathways in man. Electroencephalogr Clin Neurophysiol 69: 277–286Google Scholar
  30. 30.
    Joseph J, Howland EW, Wakai R, Backonja M, Baffa O, Potenti FM, Cleeland CS (1991) Late pain-related magnetic fields and electric potentials evoked by intracutaneous electric finger stimulation. Electroencephalogr Clin Neurophysiol 80: 46–52PubMedCrossRefGoogle Scholar
  31. 31.
    Kobal G (1985) Pain-related electrical potentials of the human nasal mucosa elicited by chemical stimulation. Pain 22: 151–163PubMedCrossRefGoogle Scholar
  32. 32.
    Kobal G, Hummel C, Nuernberg B, Brune K (1990) Effects of pentazocine and acetylsalicylic acid on pain-rating, pain-related evoked potentials and vigilance in relationship to pharmacokinetic parameters. Agents Actions 4: 342–359CrossRefGoogle Scholar
  33. 33.
    Kochs E, Treede RD, Schulte am Esch J (1986) Increase of somatosensory evoked potentials during induction of anaesthesia with etomidate. Anaesthesist 35: 359–365PubMedGoogle Scholar
  34. 34.
    Kochs E, Treede RD, Schulte am Esch J, Bromm B (1990) Modulation of pain-related somatosensory evoked potentials by general anesthesia. Anesth Analg 71: 225–230PubMedCrossRefGoogle Scholar
  35. 35.
    Kochs E, Bischoff P (1994) Anesthesia and somatosensory evoked responses. In: Schulte am Esch J, Kochs E (eds) Central nervous system monitoring. Springer, Berlin Heidelberg New York, pp 146–175Google Scholar
  36. 36.
    Koht A, Schultz W, Schmidt G, Schramm J, Watanabe E (1988) The effects of etomidate, midazolam and thiopental on median nerve somatosensory evoked potentials and the additive effects of fentanyl and nitrous oxide. Anesth Analg 67: 435–441PubMedCrossRefGoogle Scholar
  37. 37.
    Markand ON, Warren CH, Moorthey SS, Stoelting RK, King RD (1984) Monitoring of multimodally evoked potentials during open heart surgery under hypothermia. Electroencephalogr Clin Neurophysiol 59: 432–439PubMedCrossRefGoogle Scholar
  38. 38.
    Martin WR, Kay DC (1977) Effects of analgesics and antagonists on the EEG. In: Longo VG (ed) Handbook of electroencephalography and clinical neurophysiology, vol 7C. Elsevier, Amsterdam, pp 97–109Google Scholar
  39. 39.
    McPherson RW, Sell B, Traystman RJ (1986) Effects of thiopental, fentanyl, and etomidate on upper extremity somatosensory evoked potentials in humans. Anesthesiology 65: 584–589PubMedCrossRefGoogle Scholar
  40. 40.
    Miltner W, Johnson R jr, Braun C, Larbig W (1989) Somtasensory event-related potentials to painful and non-painful stimuli: effects of attention. Pain 38: 303–312PubMedCrossRefGoogle Scholar
  41. 41.
    Namerow NS (1969) Somatosensory evoked responses following cervical cordotomy. Bull Los Angeles Neurol Soc 34: 184–188PubMedGoogle Scholar
  42. 42.
    Nielsen JC, Arendt-Nielsen L, Bjerring P, Carlsson P (1991) Analgesic efficacy of low doses of intravenously administered lidocaine on experimental laser-induced pain: a placebo-controlled study. Reg Anaesth 16: 28–33Google Scholar
  43. 43.
    Nishiyama Y, Ito M (1993) Effects of isoflurane, sevoflurane and enflurane on median nerve somatosensory evoked potentials in humans. Jpwn J Anesth 42: 339–343Google Scholar
  44. 44.
    Nuwer MR (1986) Evoked potential monitoring in the operating room. Raven, New YorkGoogle Scholar
  45. 45.
    Pathak KS, Ammadio M, Kalamchi A, Scoles PV, Shaffer JW, Mackay W (1987) Effects of halothane, enflurane, and isoflurane on somatosensory evoked potentials during nitrous oxide anesthesia. Anesthesiology 66: 753–757PubMedCrossRefGoogle Scholar
  46. 46.
    Peterson DO, Drummond JC, Todd MM (1986) Effects of halothane, enflurane, isoflurane and nitrous oxide on somatosensory evoked potentials in humans. Anesthesiology 65: 35–40PubMedCrossRefGoogle Scholar
  47. 47.
    Picton TW (ed) (1989) Human event-related potentials. Elsevier Science, Amsterdam (Handbook of electroencephalography and clinical neurophysiology, vol 3 )Google Scholar
  48. 48.
    Rhodewald P, Neddermann E (1988) Dose-dependence of the analgesic action of metamizol. Anaesthesist 37: 150–155Google Scholar
  49. 49.
    Samara SK, Vanderzant CW, Domer PA, Sackellares J (1987) Differential effects of isoflurane on human median nerve somatosensory evoked potentials. Anesthesiology 66: 29–35CrossRefGoogle Scholar
  50. 50.
    Sebel PS, Heneghan CP, Ingram DA (1985) Evoked responses — a neurophysiologies indicator of depth of anesthesia? (editorial) Br J Anaesth 57: 841–842Google Scholar
  51. 51.
    Sebel PS, Withington PS, Rutherford CF, Markman K (1988) The effect of tracheal intubation and surgical stimulation on median nerve somatosensory evoked potentials during anaesthesia. Anaesthesia 43: 857–860PubMedCrossRefGoogle Scholar
  52. 52.
    Sitaram N, Buchsbaum MS, Gillin JC (1977) Physostigmine analgesia and somatosensory evoked responses in man. Eur J Pharmacol 42: 285–290PubMedCrossRefGoogle Scholar
  53. 53.
    Thiel A, Russ W, Kafurke H, Hempelmann G (1987) The effects of enflurane and isoflurane on somatosensory evoked potentials after stimulation of the median nerve. Anaesth Intensivther Notfallmed 22: 159–165CrossRefGoogle Scholar
  54. 54.
    Thiel A, Russ W, Hempelmann G (1988) Evoked potentials and volatile anaesthetics. Klin Wochenschr 66 [Suppl XIV]: 11–18Google Scholar
  55. 55.
    Thornton C (1991) Evoked potentials in anaesthesia. Eur J Anaesth 8: 89–107Google Scholar
  56. 56.
    Treede RD, Kief S, Hdlzer T, Bromm B (1988) Late somatosensory cerebral potentials in response to cutaneous heat stimuli. Electroencephalogr Clin Neurophysiol 70: 429–441PubMedCrossRefGoogle Scholar
  57. 57.
    Vandesteene A, Nogueira MC, Mavroudakis N, Defevrimont M, Brundo E, Zegers de Beyl D (1991) Topographic analysis of the effects of isoflurane anesthesia on SEP. Electroencephalogr Clin Neurophysiol 88: 77–81Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • E. Kochs

There are no affiliations available

Personalised recommendations