Washburn Nicholas R, Smith Emily
Anesthesiology, Kaweah Delta Health Care District, Visalia, USA.
Anesthesiology, Kaweah Health Medical Center, Visalia, USA.
Cureus. 2024 Sep 18;16(9):e69676. doi: 10.7759/cureus.69676. eCollection 2024 Sep.
This case report details the successful management of labor pain using epidural analgesia in a 22-year-old primigravid patient with a history of spina bifida and extensive surgical repair. Spina bifida, a congenital neural tube defect, presents unique challenges for neuraxial anesthesia due to altered spinal anatomy and potential neurological deficits. Despite these complexities, effective pain relief was achieved through careful patient counseling, comprehensive pre-procedural planning, and meticulous technique. Upon admission for labor induction due to preeclampsia, a physical examination revealed significant lumbar scarring with obscure anatomical landmarks. Despite these challenges, informed consent was obtained, and an epidural catheter was successfully placed using palpable bony prominences above the presumed T12-L1 interspace. A standard midline approach with saline loss of resistance technique was employed, epidural space was confirmed at a depth of 5 cm, and a catheter was placed. Continuous patient-controlled epidural analgesia (PCEA) comprising fentanyl and ropivacaine provided consistent pain relief throughout a 17-hour labor period, maintaining a dermatome level of T10. Post-delivery, neurosurgical evaluation confirmed successful catheter removal without complications, and the patient exhibited normal neurological function. This case underscores the importance of individualized pain management strategies in patients with spina bifida, necessitating thorough risk-benefit assessment, detailed patient education, and interdisciplinary collaboration for optimal outcomes. Despite the inherent challenges, epidural analgesia can be a viable option with careful planning and execution, contributing to improved maternal comfort and satisfaction during labor and delivery for patients with a history of spina bifida.
本病例报告详细介绍了一名22岁初产妇的分娩疼痛管理情况，该产妇有脊柱裂病史且接受过广泛的手术修复，通过硬膜外镇痛成功实现了分娩疼痛的管理。脊柱裂是一种先天性神经管缺陷，由于脊柱解剖结构改变和潜在的神经功能缺损，给椎管内麻醉带来了独特的挑战。尽管存在这些复杂性，但通过仔细的患者咨询、全面的术前规划和细致的技术操作，仍实现了有效的疼痛缓解。因先兆子痫入院引产时，体格检查发现腰椎有明显瘢痕，解剖标志模糊。尽管面临这些挑战，仍获得了知情同意，并通过触及推测的T12-L1椎间隙上方的骨性突出成功置入了硬膜外导管。采用标准的中线入路和生理盐水阻力消失技术，在5厘米深度确认了硬膜外腔，并置入了导管。由芬太尼和罗哌卡因组成的持续患者自控硬膜外镇痛（PCEA）在17小时的分娩过程中提供了持续的疼痛缓解，维持了T10皮节水平。分娩后，神经外科评估确认导管成功拔除且无并发症，患者神经功能正常。本病例强调了脊柱裂患者个体化疼痛管理策略的重要性，需要进行全面的风险效益评估、详细的患者教育以及跨学科合作以实现最佳结果。尽管存在固有挑战，但通过精心规划和执行，硬膜外镇痛对于有脊柱裂病史的患者在分娩和分娩期间改善产妇舒适度和满意度来说是一种可行的选择。
