• Michael K Urban, Kara Fields, Sean W Donegan, Jonathan C Beathe, David W Pinter, Oheneba Boachie-Adjei, and Ronald G Emerson.
• Healthcare Research Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Department of Anesthesia, Weill Cornell Medical College, 1305 York Ave, New York, NY 10021, USA.
• Spine J. 2017 Dec 1; 17 (12): 1889-1896.

Background ContextLidocaine has emerged as a useful adjuvant anesthetic agent for cases requiring intraoperative monitoring of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). A previous retrospective study suggested that lidocaine could be used as a component of propofol-based intravenous anesthesia without adversely affecting MEP or SSEP monitoring, but did not address the effect of the addition of lidocaine on the MEP and SSEP signals of individual patients.PurposeThe purpose of this study was to examine the intrapatient effects of the addition of lidocaine to balanced anesthesia on MEPs and SSEPs during multilevel posterior spinal fusion.Study DesignThis is a prospective, two-treatment, two-period crossover randomized controlled trial with a blinded primary outcome assessment.Patient SampleForty patients undergoing multilevel posterior spinal fusion were studied.Outcome MeasuresThe primary outcome measures were MEP voltage thresholds and SSEP amplitudes. Secondary outcome measures included isoflurane concentrations and hemodynamic parameters.MethodsEach participant received two anesthetic treatments (propofol 50 mcg/kg/h and propofol 25 mcg/kg/h+lidocaine 1 mg/kg/h) along with isoflurane, ketamine, and diazepam. In this manner, each patient served as his or her own control. The order of administration of the two treatments was determined randomly.ResultsThere were no significant within-patient differences between MEP threshold voltages or SSEP amplitudes during the two anesthetic treatments.ConclusionsLidocaine may be used as a component of balanced anesthesia during multilevel spinal fusions without adversely affecting the monitoring of SSEPs or MEPs in individual patients.Copyright © 2017 Elsevier Inc. All rights reserved.

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