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EP216 Epidural labour analgesia is not always contraindicated in patients with spinal dysraphism: a tethered cord syndrome case report
  1. Cristina Todde1,
  2. Marco Aversano1,
  3. Leoni Matteo Luigi Giuseppe2,
  4. Antonina Zagari3,
  5. Laura Feole4 and
  6. Maria Grazia Frigo3
  1. 1Interdepartmental Unit of Obstetric Anaesthesia and Intensive Care – Department of Emergency, Fatebenefratelli – Isola Tiberina Gemelli Isola Hospital, Roma, Italy
  2. 2Unit of Interventional and Surgical Pain Management, Guglielmo da Saliceto Hospital , Piacenza , Italy
  3. 3Interdepartmental Unit of Obstetric Anaesthesia and Intensive Care – Department of Emergency, Fatebenefratelli – Isola Tiberina Gemelli Isola Hospital, Rome, Italy
  4. 4Unit of Gynecology, Campus Biomedico University, Roma, Italy


Background and Aims Spinal dysraphism is a heterogeneous group of vertebral arches disorders with direct implications for the peripartum anaesthetic care. In fact, even if labour analgesia is a common regional anaesthetic technique to provide pain relief during labour, the presence of spinal dysraphism generally contraindicates the use of neuraxial approaches.

Methods We present the case of a 30-year-old female, ASA 2, who presented to our department at 38 weeks of gestation for pre-operative evaluation. During the clinical evaluation, a skin dimple was noted in the sacral area and no visible scoliosis was identified. An accurate neurological examination was completely negative without any related symptoms. A lumbar magnetic resonance imaging (MRI) revealed a tethered cord syndrome with an interrupted sacral posterior neural arch located at S2 and associated with an abnormally low positioned conus medullaris (figure 1).

Results Epidural analgesia was selected to avoid a possible spinal cord injury using combined spinal-epidural technique. Consequently, an epidural catheter was inserted at L2-L3 level and 10mcg epidural sufentanyl bolus followed by intermittent top-up 15-20ml ropivacaine 0.1-0.2% injections allowed an optimal pain management during the labour. No complications and adverse effects occurred in the postpartum period.

Abstract EP216 Figure 1

Sagittal (A) and axial (B) T2 weighted MRI of the lumbar spine showing an abnormally low positioned conus medullaris (L4-L5) associated with interrupted sacral posterior S2 neural arch corresponding to a skin dimple (C)

Conclusions This case suggests that a proper evaluation of spinal dysraphism is a key element to improve the labour’s anaesthetic management and for determining the feasibility of neuraxial analgesia. In fact, labour analgesia can be safely performed in well selected patients with tethered cord syndrome.

  • Epidural labour analgesia
  • spinal dysraphism

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