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B438 Dural puncture epidural for caesarean delivery in a patient with recently unstable multiple sclerosis
  1. M Sharapi1 and
  2. J Loughrey2
  1. 1Beaumont Hospital, Dublin, Ireland
  2. 2Rotunda Hospital, Dublin, Ireland


Background and Aims Multiple sclerosis is a rare disease involving demyelination of the central nervous system tissue as a result of an autoimmune mechanism. Postpartum relapse rates of 26% are described independent of neuraxial use patterns. Many practitioners will avoid spinal anaesthesia in MS.

Methods Case Description

Results A 30- year-old with a history of multiple sclerosis presented for elective Caesarean section. She reported right-sided sensory deficit in the upper and lower limb with lower limb weakness and difficulty walking in the first trimester and her neurological symptoms had resolved by the third trimester. An epidural catheter was inserted at L4/5 with needle through needle passage of a 27G pencil-point spinal needle. Clear CSF observed but no medication was administered through the spinal needle. Plain Bupivacaine 0.5% and Lidocaine 2% were administered. The patient had no pain during the procedure with adequate sensory and motor blockade. She made an uneventful recovery with no recurrence of neurological symptoms.

Conclusions A recently described technique for labour analgesia is the Dural Puncture Epidural which afforded rapid onset and reliable analgesia compared with standard epidural. We felt the DPE would enhance the efficacy of the epidural block while avoiding the concerns around direct administration of local anaesthetic into the thecal sac. The success of the technique in a single case does not render it superior to other standard neuraxial approaches. In a patient with recently active demyelination symptoms, we had increased confidence with this approach aiming to minimise the risk of disease exacerbation and maximise block success.

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