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

Cateteres peridurais duplos para analgesia de parto em paciente com lesão medular: relato de caso

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

Resumo

O impedimento da solução do anestésico local no espaço peridural resulta em alívio insatisfatório da dor durante o trabalho de parto peridural. Pacientes com história de trauma nas costas e instrumentação espinhal têm taxas aumentadas de falha epidural devido à dispersão irregular de anestésico local com espaço epidural obliterado. Cateteres epidurais duplos (CED) podem ser usados em tais cenários clínicos com analgesia de trabalho de parto completa e maior satisfação do paciente. Apresentamos o manejo bem-sucedido de uma parturiente com fratura vertebral com risco de falha epidural e lesão neurológica devido a inserção cranial e caudal de fragmentos ósseos à vértebra fraturada usando ultrassom para evitar sequelas neurológicas.

Palavras-chave

Anestesia peridural; Injeções epidurais; Analgesia obstétrica; Lesão da medula espinal

References

1. Jain NB, Ayers GD, Peterson EN, et al. Traumatic spinal cord injury in the United States, 1993-2012. JAMA. 2015;313:2236 −43.

2. Obstetric Management of Patients with Spinal Cord Injuries: ACOG. Committee Opinion, Number 808. Obstet Gynecol. 2020;135:e230−6.

3. Arendt K, Segal S. Why epidurals do not always work. Rev Obstet Gynecol. 2008;1:49−55.

4. Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004;13:227−33.

5. Moore A, Villeneuve V, Bravim B, et al. The labor analgesia requirements in nulliparous women randomized to epidural catheter placement in a high or low intervertebral space. Anesth Analg. 2017;125:1969−74.

6. Li JZ, Wang MS, Ji XH, et al. Efficacy and delivery outcomes of women underwent double-catheter epidural block during labor. Zhonghua Fu Chan Ke Za Zhi. 2010;45:819−24.

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Braz J Anesthesiol

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