Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Neuromodulation. 2010 Oct;13(4):270-4. doi: 10.1111/j.1525-1403.2010.00288.x.
The use of spinal cord stimulation (SCS) is a form of neuromodulation used to treat chronic pain in those patients who are refractory to conventional medical management. Not uncommonly, SCS can dramatically improve a patient's quality of life, and those who are in the childbearing years may go on to become pregnant. The purpose of this case series is to describe: 1) implantation considerations in women of childbearing age; 2) use of rechargeable systems; 3) the obstetric and anesthetic concerns in patients with spinal cord stimulators; 4) risks of using SCS in the peripartum period.
Two female patients with complex regional pain syndrome I (CRPS I) who were well managed with SCS became pregnant. In both patients, the leads were placed through the T12/L1 interspace and the generator was placed in the buttock region. In the first patient, the device was deactivated prior to conception and maintained off for the duration of the pregnancy. The second patient became pregnant on two separate occasions, with active SCS for a portion of the first trimester. During her second pregnancy, the patient elected to use of SCS at 30 weeks' gestation.
The developing fetuses with intrauterine exposure to SCS were followed out for a minimum of two years and are developmentally normal. The physical presence of the device did not complicate obstetric or anesthetic care. Rechargeable SCS systems were not adversely affected when turned off for the duration of the pregnancy.
Implantation of SCS devices in women of childbearing years should take into account the future needs of both obstetric and anesthetic care by avoiding the abdomen and lower lumbar spine whenever possible. There was no appreciable decline of battery capacity in present day constant current rechargeable generators when deactivated for the duration of pregnancy.
脊髓刺激（SCS）的使用是一种神经调节形式，用于治疗对常规医学治疗有抵抗力的慢性疼痛患者。通常情况下，SCS 可以显著提高患者的生活质量，那些处于生育年龄的患者可能会怀孕。本病例系列的目的是描述：1）生育年龄女性的植入考虑因素；2）使用可充电系统；3）脊髓刺激器患者的产科和麻醉问题；4）围产期使用 SCS 的风险。
两名患有复杂性区域疼痛综合征 I（CRPS I）的女性患者，SCS 治疗效果良好，随后怀孕。在这两名患者中，导线均通过 T12/L1 间隙放置，发生器放置在臀部区域。在第一例患者中，在怀孕前停用设备，并在整个怀孕期间保持关闭状态。第二例患者两次怀孕，第一次怀孕初期部分时间使用 SCS。在第二次怀孕时，患者选择在 30 周妊娠时使用 SCS。
在子宫内暴露于 SCS 的发育中胎儿至少随访了两年，发育正常。设备的存在并未使产科或麻醉护理复杂化。在整个怀孕期间关闭时，可充电 SCS 系统并未受到不利影响。
在生育年龄的女性中植入 SCS 装置时，应尽可能避免腹部和下腰椎，以考虑到未来产科和麻醉护理的需求。目前的恒流可充电发电机在怀孕期间停用一段时间后，电池容量没有明显下降。
