Bates Rachel, Cave Fiona, West Nicholas, Bone Jeffrey N, Hofmann Bradley, Miyanji Firoz, Lauder Gillian R
Department of Anesthesia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Research Institute, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Paediatr Anaesth. 2025 Jan;35(1):47-56. doi: 10.1111/pan.15019. Epub 2024 Oct 5.
Posterior spinal instrumentation and fusion is an established surgical procedure for the correction of adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring is standard practice for this procedure. Anesthetic agents can have different, but significant, effects on neurophysiological monitoring outcomes.
To determine if intravenous lidocaine infusion therapy has an impact on the intraoperative neurophysiological monitoring during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis.
Following ethical approval, we conducted a retrospective review of charts and the archived intraoperative neurophysiological data of adolescents undergoing posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring data included the amplitude of motor evoked potentials and the amplitude and latency of somatosensory evoked potentials. A cohort who received intraoperative lidocaine infusion were compared to those who did not.
Eighty-one patients were included in this analysis, who had surgery between February 4, 2016 and April 22, 2021: 39 had intraoperative intravenous lidocaine infusion and 42 did not. Based on hourly snapshot data, there was no evidence that lidocaine infusion had a detrimental effect on the measured change from baseline for MEP amplitudes in either lower (mean difference 41.9; 95% confidence interval -304.5 to 388.3; p = .182) or upper limbs (MD -279.0; 95% CI -562.5 to 4.4; p = .054). There was also no evidence of any effect on the measured change from baseline for SSEP amplitudes in either lower (MD 16.4; 95% CI -17.7 to 50.5; p = .345) or upper limbs (MD -2.4; 95% CI -14.5 to 9.8; p = .701). Finally, there was no evidence of a difference in time to first reportable neurophysiological event (hazard ratio 1.13; 95% CI 0.61 to 2.09; p = .680).
Data from these two cohorts provide preliminary evidence that intravenous lidocaine infusion has no negative impact on intraoperative neurophysiological monitoring during PSIF for adolescent idiopathic scoliosis.
后路脊柱内固定融合术是矫正青少年特发性脊柱侧凸的一种成熟外科手术。术中神经生理监测是该手术的标准操作。麻醉药物对神经生理监测结果会产生不同但显著的影响。
确定静脉输注利多卡因疗法对青少年特发性脊柱侧凸后路脊柱内固定融合术中的术中神经生理监测是否有影响。
经伦理批准后，我们对接受青少年特发性脊柱侧凸后路脊柱内固定融合术的青少年的病历和存档的术中神经生理数据进行了回顾性分析。术中神经生理监测数据包括运动诱发电位的波幅以及体感诱发电位的波幅和潜伏期。将术中接受利多卡因输注的一组患者与未接受输注的患者进行比较。
本分析纳入了81例在2016年2月4日至2021年4月22日期间接受手术的患者：39例术中接受了静脉输注利多卡因，42例未接受。根据每小时的即时数据，没有证据表明利多卡因输注对下肢（平均差异41.9；95%置信区间-304.5至388.3；p = 0.182）或上肢（平均差异-279.0；95%置信区间-562.5至4.4；p = 0.054）运动诱发电位波幅相对于基线的测量变化有不利影响。也没有证据表明对下肢（平均差异16.4；95%置信区间-17.7至50.5；p = 0.345）或上肢（平均差异-2.4；95%置信区间-14.5至9.8；p = 0.701）体感诱发电位波幅相对于基线的测量变化有任何影响。最后，没有证据表明首次可报告神经生理事件的时间存在差异（风险比1.13；95%置信区间0.61至2.09；p = 0.680）。
这两组数据提供了初步证据，表明静脉输注利多卡因对青少年特发性脊柱侧凸后路脊柱内固定融合术中的术中神经生理监测没有负面影响。
