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Changes in motor evoked potentials after erector spinae block in scoliosis surgery—when to take pre-incision baseline recordings?

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Abstract

Multimodal intraoperative neurophysiological monitoring (IONM) is highly valuable in scoliosis surgeries for monitoring spinal cord function, particularly during instrumentation. Accurate timing of baseline recordings of TcMEP and SSEP is crucial, as any changes observed during surgery and instrumentation are compared to these baseline recordings. However, the impact of ultrasound-guided erector spinae block (USG-ESPB) on SSEP and TcMEP is not well-studied in scoliosis surgery. In this report, we present two cases of scoliosis surgery where bilateral two-level USG-ESPB using different concentrations of ropivacaine (0.375% and 0.2%) resulted in a transient and significant deterioration of TcMEP, occurring 3 minutes after the block and lasting for 20 minutes. Remarkably, SSEPs remained unchanged during this period. These findings suggest that USG-ESPB may produce TcMEP changes, highlighting the importance of carefully considering the timing of baseline TcMEP acquisition in scoliosis surgery.

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Acknowledgements

The authors would like to thank Mr Alwyn Menezes-anesthesia technician, surgeons (Dr Tanmoy Maiti and Dr Nader H) and operating room nursing staff at Cleveland Clinic Abu Dhabi for the help and support during the cases.

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Authors and Affiliations

  1. Anesthesia Institute, Cleveland Clinic, Abu Dhabi, UAE

    Nitin Manohara, Clara Lobo, Vinay Byrappa & Francisco A Lobo

  2. Neurophysiology, Cleveland Clinic, Abu Dhabi, UAE

    Vania Pinto

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  1. Nitin Manohara
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  2. Vania Pinto
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  3. Clara Lobo
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  4. Vinay Byrappa
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  5. Francisco A Lobo
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Contributions

Nitin Manohara, Vania Pinto and Clara Lobo conceptualised the methdology and wrote the main manuscript. Vinay Byrappa and Francisco Lobo helped with manuscript editing and all authors reviewed the manuscript.

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Correspondence to Nitin Manohara.

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The current work has been done with institutional resources and the authors have not received any financial support for the work. The authors do not have any conflict of interest in the material.

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Manohara, N., Pinto, V., Lobo, C. et al. Changes in motor evoked potentials after erector spinae block in scoliosis surgery—when to take pre-incision baseline recordings?. J Clin Monit Comput 38, 229–234 (2024). https://doi.org/10.1007/s10877-023-01058-6

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