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EP221 Between a rock and a hard place: Epidural anesthesia for a caesarean delivery in a woman with diaphragmatic paralysis – a case report
  1. Alexandrina Silva,
  2. David Silva Meireles,
  3. Cristina Salta and
  4. Teresa Rocha
  1. Anesthesiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal


Background and Aims Diaphragmatic paralysis (DP) can pose challenges during caesarean delivery (CD), as it may increase the risk of respiratory complications. While there is limited information on anesthesia techniques for patients with DP, central nerve blocks sparing upper intercostal muscles have been utilised in similar procedures.

Methods A 20-year-old woman with idiopathic diaphragmatic paralysis who required an emergent CD due to persistent variable fetal decelerations and intrapartum fever in the labour ward. Diaphragmatic paralysis was incidentally discovered during investigations for recurrent syncope, with no identifiable cause. The patient had a functional capacity of 5 METs. Epidural anesthesia (EA) was performed using titrated ropivacaine 0.75% through an epidural catheter, which had been placed at the beginning of the first stage of labor, 12 hours prior to the development of fever. A total volume of 14mL of ropivacaine was administered. Standard ASA monitoring, multimodal analgesia, and broad-spectrum antibiotics were employed.

Results The patient remained hemodynamically stable and ventilated spontaneously throughout an uneventful CD. No respiratory or neurological complications were observed in the postoperative period.

Conclusions The compressive effect of the dural sac allowed us to limit the spread of local anaesthetic, sparing upper thoracic myotomes. Although EA is an option in patients with diaphragmatic paralysis, decisions should be tailored to individual cases. Further studies are needed to evaluate the impact of EA on patients with diaphragm lung paralysis and other restrictive lung diseases.

  • Epidural
  • cesarean
  • respiratory complications
  • diaphragm paralysis

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