Epidural analgesia in parturients with previous spinal irradiation

To present two successful cases of labour analgesia in patients who had been treated with radiation to the lumbar spine for neuroblastomas and to discuss the considerations when planning the anaesthetic management of these patients. We recently encountered two primigravidas requesting labour analges...

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Bibliographic Details
Published in:Canadian journal of anesthesia 1998-09, Vol.45 (9), p.884-887
Main Authors: HILTON, A. B. R, LOCKHART, E. M, PENNING, D. H
Format: Article
Language:English
Subjects:
Abdominal surgery. Urology. Gynecology. Obstetrics
Adolescent
Adult
Analgesia, Epidural - instrumentation
Analgesia, Epidural - methods
Analgesia, Obstetrical - instrumentation
Analgesia, Obstetrical - methods
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Anesthesia
Anesthesia depending on type of surgery
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Local - administration & dosage
Biological and medical sciences
Bupivacaine - administration & dosage
Female
Fentanyl - administration & dosage
Fentanyl - therapeutic use
Humans
Lidocaine - administration & dosage
Lumbar Vertebrae - radiation effects
Medical sciences
Neuroblastoma - radiotherapy
Patient Care Planning
Pregnancy
Procaine - administration & dosage
Procaine - analogs & derivatives
Scoliosis - complications
Spinal Puncture - instrumentation
Spinal Puncture - methods
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Summary:To present two successful cases of labour analgesia in patients who had been treated with radiation to the lumbar spine for neuroblastomas and to discuss the considerations when planning the anaesthetic management of these patients. We recently encountered two primigravidas requesting labour analgesia, both of whom were noted to have very thin backs with prominent spinous processes and obvious scoliosis. In both patients, the epidural space was easily identified and very shallow. Successful labour analgesia was achieved in both patients, one with a combined spinal epidural technique and the other with an epidural catheter. Craniospinal irradiation is known to have long-term effects on exposed nervous tissue, bone, and blood vessels. While a larger experience is necessary to demonstrate safety of regional anaesthesia in parturients following previous spinal irradiation, we provide reports of two successful cases.
ISSN:0832-610X
1496-8975
DOI:10.1007/BF03012224