Reysner Malgorzata, Reysner Tomasz, Janusz Piotr, Kowalski Grzegorz, Geisler-Wojciechowska Alicja, Grochowicka Monika, Pyszczorska Monika, Mularski Aleksander, Wieczorowska-Tobis Katarzyna
Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
NeuroSci. 2024 Dec 17;5(4):693-712. doi: 10.3390/neurosci5040049.
Intraoperative neuromonitoring (IONM) is crucial for the safety of scoliosis surgery, providing real-time feedback on the spinal cord and nerve function, primarily through motor-evoked potentials (MEPs). The choice of anesthesia plays a crucial role in influencing the quality and reliability of these neuromonitoring signals. This systematic review evaluates how different anesthetic techniques-total intravenous anesthesia (TIVA), volatile anesthetics, and regional anesthesia approaches such as Erector Spinae Plane Block (ESPB), spinal, and epidural anesthesia-affect IONM during scoliosis surgery.
A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for studies published between 2017 and 2024 that examined the impact of anesthetic techniques on neuromonitoring during scoliosis surgery. The focus was on studies reporting MEP outcomes, anesthetic protocols, and postoperative neurological and analgesic effects.
The search initially identified 998 articles. After applying inclusion criteria based on relevance, recency, methodological quality, and citation frequency, 45 studies were selected for detailed review.
The erector Spinae Plane Block (ESPB) provides distinct benefits over spinal and epidural anesthesia in scoliosis surgery, particularly in maintaining neuromonitoring accuracy, reducing hemodynamic instability, and minimizing complications. The ESPB's ability to deliver effective segmental analgesia without compromising motor function makes it a safer and more efficient option for postoperative pain management, enhancing patient outcomes.
术中神经监测（IONM）对脊柱侧弯手术的安全性至关重要，主要通过运动诱发电位（MEP）对脊髓和神经功能提供实时反馈。麻醉方式的选择在影响这些神经监测信号的质量和可靠性方面起着关键作用。本系统评价评估了不同的麻醉技术——全静脉麻醉（TIVA）、挥发性麻醉剂以及区域麻醉方法，如竖脊肌平面阻滞（ESPB）、脊髓麻醉和硬膜外麻醉——在脊柱侧弯手术中如何影响IONM。
按照PRISMA指南进行系统评价。在PubMed、MEDLINE、EMBASE和Cochrane数据库中检索2017年至2024年发表的研究，这些研究探讨了麻醉技术对脊柱侧弯手术中神经监测的影响。重点是报告MEP结果、麻醉方案以及术后神经和镇痛效果的研究。
检索最初识别出998篇文章。在根据相关性、时效性、方法学质量和引用频率应用纳入标准后，选择了45项研究进行详细审查。
在脊柱侧弯手术中，竖脊肌平面阻滞（ESPB）相对于脊髓麻醉和硬膜外麻醉具有明显优势，特别是在维持神经监测准确性、减少血流动力学不稳定以及将并发症降至最低方面。ESPB能够提供有效的节段性镇痛而不影响运动功能，使其成为术后疼痛管理的更安全、更有效的选择，可改善患者预后。
