Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2022.03.001
Brazilian Journal of Anesthesiology
Case Report

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report

Ejaz Khan, David Garcia, Shaopeng Huang, Roni Mendonca, Rakesh Vadhera

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Abstract

Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.

Keywords

Epidural anesthesia;  Epidural injections;  Obstetrical analgesia;  Spinal cord injury

References

1 N.B. Jain, G.D. Ayers, E.N. Peterson, et al. Traumatic spinal cord injury in the United States, 1993-2012 JAMA, 313 (2015), pp. 2236-2243

2 Obstetric Management of Patients with Spinal Cord Injuries: ACOG Committee Opinion, Number 808 Obstet Gynecol, 135 (2020), pp. e230-e236

3 K. Arendt, S. Segal Why epidurals do not always work Rev Obstet Gynecol, 1 (2008), pp. 49-55

4 P.H. Pan, T.D. Bogard, M.D. Owen Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries Int J Obstet Anesth, 13 (2004), pp. 227-233

5 A. Moore, V. Villeneuve, B. Bravim, et al. The labor analgesia requirements in nulliparous women randomized to epidural catheter placement in a high or low intervertebral space Anesth Analg, 125 (2017), pp. 1969-1974

6 J.Z. Li, M.S. Wang, X.H. Ji, et al. Efficacy and delivery outcomes of women underwent double-catheter epidural block during labor Zhonghua Fu Chan Ke Za Zhi, 45 (2010), pp. 819-824

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Braz J Anesthesiol

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