title: Effects of intrathecal morphine on transcranial electric motor-evoked potentials in adolescents undergoing posterior spinal fusion.
abstract: BACKGROUND
  Intrathecal morphine (ITM) provides effective analgesia after posterior spinal fusion (PSF). Although most anesthetic drugs have well-characterized effects on evoked potentials, there is little data on the effects of ITM on transcranial electric motor-evoked potentials (tceMEPs). We performed this study to assess the effects of ITM on tceMEPs in the first 30 minutes after administration. We hypothesized that administration of ITM in doses currently used at our institution would not significantly affect mean tceMEP amplitudes and latencies of an ITM study group relative to control patients who did not receive the drug.
  
  
  METHODS
  tceMEPs were recorded before ITM injection and 5, 10, 20, and 30 minutes after injection in 14 subjects ages 11 through 18 years undergoing PSF. These recordings were compared to an age-matched control group undergoing PSF in which ITM was not injected. The effects of ITM on tceMEP amplitude and latency were compared between the 2 groups.
  
  
  RESULTS
  Fourteen subjects were enrolled in the ITM group and 16 served as controls. There were no significant differences in the baseline mean response amplitudes of the 2 groups for any of the 8 muscles studied. Mean response amplitudes over the 30-minute posttreatment period in the ITM group did not differ significantly from those of the control subjects. Average response amplitudes collapsed across all muscles for each subject were not significantly different during the baseline period (95% CI = -38% to 45%; P = 0.783), nor were they significantly different between the 2 groups during the posttreatment period (95% CI = -30% to 78%; P = 0.640). There also were no significant differences in the mean response latencies of the 2 groups in either the baseline or posttreatment periods. Average response latencies collapsed across all muscles for each subject were 4% larger for the ITM group than for controls during the baseline period (95% CI = -5% to 13%; P = 0.377), and 3% larger for the ITM group than for controls during the posttreatment period (95% CI = -4% to 12%; P = 0.359).
  
  
  CONCLUSIONS
  Administration of ITM in doses currently used at our institution did not cause more than a 70% attenuation of mean tceMEP amplitudes or latency changes of an ITM study group relative to control subjects during the 30-minute period after injection. Further studies are required to determine if there are delayed effects after this initial time period.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34 Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA. strickerp@email.chop.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Stricker
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Sestokas
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwartz
authors.forename: Vidya
authors.initials: V
authors.lastname: Bhalodia
authors.forename: Ankit
authors.initials: A
authors.lastname: Pahwa
authors.forename: John P
authors.initials: JP
authors.lastname: Dormans
authors.forename: Lia L
authors.initials: LL
authors.lastname: LaBrant
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Burgess
authors.forename: F
authors.initials: F
authors.lastname: Wickham Kraemer
authors.forename: Arjunan
authors.initials: A
authors.lastname: Ganesh
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D016022:Case-Control Studies; D002648:Child; D004558:Electric Stimulation; D004569:Electroencephalography; D019054:Evoked Potentials, Motor / Q000187:drug effects*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009020:Morphine / Q000008:administration & dosage*; D015143:Philadelphia; D011446:Prospective Studies; D011930:Reaction Time / Q000187:drug effects; D013123:Spinal Fusion; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine