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Abstract
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Background and Aims Epidural anaesthesia remains the gold-standard for labour analgesia due to its superiority over other alternatives. However, patients with Brugada syndrome pose a significant challenge due to the risks of local anaesthetics triggering malignant arrhythmias. We present the case of a primigravid patient who had a combined spinal-epidural technique for labour analgesia.
Methods A 40-year-old primigravida patient presented in early labour at 39 weeks gestation and requested for a normal vaginal delivery. Her past medical history was significant for Brugada syndrome that was diagnosed based on ECG findings and a positive family history. Following a multi-disciplinary consult between obstetrics, cardiology and anaesthesiology, an analgesia and delivery plan was formulated for her. Initial analgesia control would be provided by patient-controlled analgesia (PCA) with remifentanil, escalating to a combined spinal-epidural should her pain remain unbearable.
Results Her labour progressed and as her contraction pains got more severe, she was started on a PCA remifentanil. Subsequently, the contraction pains became unbearable despite escalation of the PCA remifentanil settings. Hence, a combined spinal-epidural was performed but no epidural medication was administered initially in order to minimise the amount of local anaesthetic delivered. When the spinal component started wearing off and her contractions became unbearable again, a low dose epidural infusion was started to good effect and the patient delivered a healthy baby uneventfully.
Conclusions Labour epidural with local anaesthetics can be administered safely to parturients with Brugada syndrome, as long as safety modifications and appropriate caution is practiced.
ECG showing Brugada pattern