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#36514 Cesarean section in a pregnant women with adhesive arachnoiditis and chronic pain – a case report
  1. Filipa Farias1,
  2. Ana Mendes Duarte2 and
  3. Teresa Rocha1
  1. 1Anesthesiology, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  2. 2Centro Hospitalar Lisboa Central, Lisboa, Portugal


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Background and Aims Adhesive arachnoiditis (AA) is a chronic, rare and debilitating disease. Characterized by persistent arachnoid inflammation leading to intrathecal scars and dural adhesions, resulting in ischemia, encapsulation, and atrophy of nerve roots. Clinical manifestations include chronic back pain and variable neurological deficits. Anaesthetic challenges include chronic pain management, baby withdrawal syndrome and difficult neuraxial approach.

Methods A 39-year old pregnant woman was scheduled for elective cesarean section due to maternal pathology. Presented with adhesive arachnoiditis, severe lumbosciatalgia, and treated pregestationally with hydromorphone, morphine, baclophene, gabapentine and diazepam. Showed neurologic deficits such as gait impairment, urinary incontinence, spasticity and paresthesia of the lower limbs. Other relevant history included: Chron’s disease, asthma, obesity, gestational diabetes and multiple previous vertebral procedures. General anesthesia was induced using propofol and rocuronium, and maintained with sevoflurane. Tracheal intubation accomplished through videolaringoscopy. Intraoperative analgesia included fentanyl, paracetamol and ketorolac. Multimodal postoperative analgesia was ensured, combining a bilateral TAP block using ropivacaine, paracetamol, ketorolac and a fentanyl Patient Controlled Analgesia (PCA).

Results Successful cesarian section performed under general anesthesia, with no complications for mother or baby. Postoperative daily evaluation revealed mild pain and nausea, treated effectively with ondansetron. Fentanyl PCA was suspended 48 hours postoperatively.

Conclusions AA patients can be challenging for the anaesthesiologist due to limitations in the neuraxial approach – an especially important anaesthesia technique in labour – and the management of postoperative acute pain in a patient with chronic pain. The described approach may be a safe and effective choice for AA patients undergoing cesarian section.

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