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#35887 Successful management of labor epidural analgesia for a nulliparous woman with prior spinal surgery of congenital scoliosis and tibial deficiency
  1. Natsumi Kii1,
  2. Motonobu Kimizuka1,
  3. Masayuki Someya2 and
  4. Michiaki Yamakage1
  1. 1Department of anaesthesiology, Sapporo Medical University, Sapporo, Japan
  2. 2Department of obstetrics, Sapporo Medical University, Sapporo, Japan


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Background and Aims Administration of epidural analgesia in a patient with prior spinal surgery is a unique challenge. There may be difficulty of locating epidural space, interference with local anaesthetic spread, and accidental dural puncture. Also, appropriate deliver position is known as one of the key of successful vaginal delivery. It may be difficullt for those who has disability of lower extremity.

Methods Written informed consent was obtained from the patient for presentation. A 29-year-old nulliparous woman was sent for evaluation of epidural analgesia use in 35th gestational weeks. She took osseointegration limb surgery in infancy, and T3-L1 posterior interbody fusion and L1-L3 lateral interbody fusion at age 13 and 15. MRI showed that lumber epidural space was intact. There were no neurologic impairments of both upper and lower extremities and she assumed a delivery position with her artificial leg. After review of these evaluation, she was offered labor epidural anaesthesia.

Results She presented at 39 weeks in labor. Epidural anaesthesia was successfully placed at L3/4. A total dose of 5.7ml of 0.2% levobupivacaine and 25 μg of fentanyl were injected in increments, and the patient reported Numerical Rating Scale 0. With using programmed intermittent epidural bolus, epidural anaesthesia provided satisfactory analgesia. She delivered a healthy baby vaginally with no adverse events.

Conclusions Although Labor epidural anaesthesia is known to be technically difficult in patients with prior spinal surgery, neuraxial anaesthesia can be performed safely and effectively in this case. An appropriate pre-labor assessment is needed for the patients with those difficulties.

  • labor epidural analgesia
  • prior spinal surgery
  • congenital scoliosis
  • tibial deficiency

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