Intravenous lidocaine infusion therapy and intraoperative neurophysiological monitoring in adolescents undergoing idiopathic scoliosis correction
A retrospective study
Pediatric Anesthesia
Submitted November 2024 by Dr Elizabeth Dalton
Read by 43 Journal Watch subscribers
This was a single-centre retrospective study aimed at determining whether intravenous lignocaine infusion therapy during posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis impacts the reliability of intraoperative neurophysiological monitoring.
Study overview:
Data from charts and archived intraoperative neurophysiological records were collected. Patients aged 10–19 years, classified as ASA 1-3, who underwent single-stage PSIF with or without traction were included. Patients who received intraoperative lignocaine infusions were compared to those who did not. Data was retrieved from medical records from 2012 to 2021. Eighty-one patients were included, of whom 39 received lignocaine and 42 did not.
Neurophysiological data collected included the amplitude of motor evoked potentials (MEP) and the amplitude and latency of somatosensory evoked potentials (SSEPs). Significant intraoperative neuromonitoring events were identified by reviewing data for changes that met clinical alert criteria. All patients who received lignocaine infusions were consistently administered a 1 mg/kg bolus followed by an infusion of 2 mg/kg/hr for the duration of the operation. Demographic variables between the two groups were evaluated.
Results:
The study found no evidence that lignocaine infusion had a harmful effect on the measured changes from baseline for MEP/SSEP amplitudes in either the upper or lower limbs. Additionally, there was no difference in the time to the first neurophysiological event.
Discussion:
PSIF is associated with significant postoperative pain. There is emerging evidence in the paediatric population to suggest safety and efficacy of intraoperative intravenous lignocaine as an opioid-sparing analgesic technique. Identifying whether lignocaine infusion negatively impacts intraoperative neuromonitoring would help justify its use in spinal surgery.
It is challenging to draw firm conclusions based on this study due to its single-centre design and small sample size. This limits the power to detect significant differences and the authors acknowledge they had to use wider confidence intervals to do so. The anaesthetic regimen was not standardized, patient risk factors were not matched, and there was variability in reporting neurophysiological parameters due to advancing technology over the period of the study. While this initial research shows promise, further prospective studies are essential to draw safe conclusions regarding the utilisation of lignocaine infusions in this population.
