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- Title
Labour epidural analgesia in an obese parturient with severe preeclampsia and scoliosis.
- Authors
Mathew, Gisha; Korichi, Noureddine; John, Ajinu
- Abstract
Background: Labour analgesia blocks the aggravated sympathetic overactivity due to labor pains in preeclampsia.1 Performing regional anesthesia in obese parturients with severe scoliosis poses challenges due to technical difficulties and alterations in epidural space.2 Case presentation: A 24-year-old primigravida (40 weeks, weight 111kg, Body Mass Index 41) presented to our emergency department with mild contractions and hypertension (156/110mmHg, proteinuria 3 þ). Systemic examination and laboratory tests including platelets were normal. Airway assessment showed Mallampati class 3. No prior Pulmonary Function Test or cardiologic evaluation was done. Xray of the abdomen showed altered thoracolumbar lordosis with double curve scoliosis (Figure 1). The thoracolumbar scoliosis was convex to left with cobb's angle 658 (severe .408) and cervicothoracic scoliosis was convex to right (cobb's angle 408). She was started on labetalol infusion, and the anesthesiologist was paged for labor analgesia. Using ultrasound guidance, the epidural space was reached at 8 cm, in a sitting position by orienting the needle towards the convexity of curvature in L3, L4 interspace. 10 ml 0.125% levobupivacaine with Fentanyl 2 mcg/ml was given as bolus and Patient Controlled Epidural Analgesia infusion started at 6 ml/hr, bolus 10 ml and lockout interval 20 minutes. The patient reported pain relief within 15 to 20 minutes and remained pain-free during her vaginal delivery keeping her blood pressure (BP) almost in a normal range. Findings/Recommendations: Working epidurals provide pain relief, minimize BP aggravations, and can be extended to provide anesthesia if a caesarean is needed.1 This improves the uteroplacental blood flow and neonatal outcome. Epidurals mitigate the exaggerated cardiovascular response to intubation during difficult airway management in obese patients with Pregnancy Induced Hypertension (PIH). Conclusion: Epidural analgesia controls BP during labor in PIH. Ultrasound-guided technique is a highly reliable technique, especially in difficult cases like scoliosis.3 In scoliosis, neuraxial procedures warrant careful titration of drugs due to reduced subarachnoid space.
- Subjects
ADOLESCENT idiopathic scoliosis; EPIDURAL analgesia; SCOLIOSIS; PREECLAMPSIA; EPIDURAL space; PULMONARY function tests; LABETALOL; LABOR pain (Obstetrics); BUPIVACAINE; PREGNANT women; FENTANYL; CONFERENCES &; conventions; PATIENT-controlled analgesia; LORDOSIS; OBESITY in women; LUMBAR vertebrae; THORACIC vertebrae
- Publication
Journal of Emergency Medicine, Trauma & Acute Care, 2022, Vol 2022, Issue 1, p1
- ISSN
1999-7086
- Publication type
Article
- DOI
10.5339/jemtac.2022.qhc.47