Intrathecal Morphine on Transcranial Electric Motor-Evoked Potentials

• Status: Completed
• Trial end date: 2009-04-01
• Target enrollment: 0
• Participant gender: All

Summary

Patients undergoing posterior spinal fusion (PSF) procedures for scoliosis are at risk for iatrogenic neurologic injury of the spinal cord and/or spinal nerve roots during surgical correction of the abnormal spinal curvature. The degree of neurologic injury can range from minor sensory deficits to complete paraplegia. Surgeons at CHOP utilize neurophysiologists to identify impending neurologic injury. These consultants monitor spinal cord pathways by recording and analyzing evoked potentials during the operation. Evoked potentials are low voltage electrical signals generated in response to transcranial or transcutaneous electrical stimulation of motor and sensory neural pathways.

Some patients undergoing PSF receive an injection of morphine into the cerebrospinal fluid during the operation. This intrathecal (IT) morphine has potent analgesic effects. While most commonly used anesthetic agents have well-characterized effects on evoked potentials, little data exists on the effects of IT morphine on transcranial electric motor-evoked potentials (TceMEPs).

This is a prospective observational study to characterize the effects of IT morphine on TceMEPs.

• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Children's Hospital of Philadelphia
• Treatments: Morphine

Criteria

Inclusion Criteria:

Intrathecal Morphine Group:

1. All patients with idiopathic scoliosis aged 11 through and including 18 who present to CHOP for posterior spinal fusion will be eligible

2. Patients with procedures anticipated to extend to or below the second lumbar vertebral level

3. Only patients given intrathecal morphine after curve correction and instrumentation will be studied

Control Group:

1. All patients with idiopathic scoliosis aged 11 through and including 18 who present to CHOP for posterior spinal fusion will be eligible

2. Patients with procedures not anticipated to extend to or below the second lumbar vertebral level

3. Patients who do not receive IT morphine injection as part of their routine anesthetic care

Exclusion Criteria:

Intrathecal Morphine Group:

1. Patients who receive inhaled anesthetic agents before or during the 30 minutes following IT morphine injection

2. Patients who receive neuromuscular blocking drugs within an hour before or during the 30 minutes following IT morphine injection.

3. Patients who develop significant changes in TceMEPs prior to intrathecal morphine injection

4. Patients with intraoperative hemodynamic instability which requires continuous vasoactive drug infusion (e.g., dopamine)

5. Patients with neuromuscular, congenital, or other non-idiopathic scoliosis

6. Pregnant or lactating females

Control Group:

1. Patients who receive inhaled anesthetic agents before or during the 30 minutes following IT morphine injection

2. Patients who receive neuromuscular blocking drugs within an hour before or during the 30 minutes following IT morphine injection.

3. Patients who develop significant changes in TceMEPs prior to the study interval

4. Patients with intraoperative hemodynamic instability which requires continuous vasoactive drug infusion (e.g., dopamine)

5. Patients with neuromuscular, congenital, or other non-idiopathic scoliosis

6. Pregnant or lactating females