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Background and Aims Spina bifida occulta, a relatively common neurologic anomaly (12.4%) (1), presents challenges for neuroaxial anesthesia although, it is not a contraindication to this technique (2).
Methods A 25-year-old woman, 39 weeks pregnant in labor was admitted in the hospital. No past medical history was described. The anesthesia team was called in as the patient was experiencing uncontrolled pain but refused the placement of an epidural catheter. During the discussion, she disclosed that she had spina bifida and believed that epidural catheter placement was contraindicated for individuals with this condition. Confirmation of spina bifida at the L5-S1 level was obtained from a CT scan in her digital records. Despite attempts to alleviate her pain with patient-controlled analgesia (PCA) with bolus of 1 ml of remifentanil (20 mcg/mL), the patient remained with bursts of pain. The PCA was stopped 20 minutes before birth however, the newborn experienced respiratory difficulties with an APGAR 6/7/8, that resolved after measures from the neonatal care.
Conclusions Epidural analgesia with lumbar catheter placement is the preferred method for labor pain management, benefiting both the mother and the fetus
(1). This decision should be made in line with the patient, that should be informed of the multiple techniques for labor pain control in advance. Effective communication between obstetric and anesthesia team can provide time and logistic management of the patient namely with a pre- procedural evaluation, ultrasound guidance and consideration of alternative techniques. This approach can provide better care to the patient with better satisfaction and outcomes.
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