Epidural pressure during infusion of saline in the parturient

Interscapular pain during cesarean delivery under epidural anesthesia

“…Epidural pressure was thought to compress the thoracic spinal cord and produce transient radicular pain from nerve root compression. 3 Although we have not definitively elucidated the etiology of interscapular pain with epidural injection, our published report in addition to the prospective study by Shah strongly suggests high epidural space pressure to be causative. Perhaps McKeown and Watson have come across a completely different or additive explanation for this neuraxial complication, as it is interesting to note that they report relief with lateral positioning, as well as instantaneous resolution upon delivery of the neonate.…”

“…Supporting this highpressure hypothesis, Shah previously published a report of epidural saline infusions used prophylactically after inadvertent dural puncture. 3 While measuring epidural pressures, the author noted that 4 out of 17 patients complained of severe interscapular pain during the infusion, and that the epidural pressure in these 4 patients was higher than in patients without interscapular pain. Epidural pressure was thought to compress the thoracic spinal cord and produce transient radicular pain from nerve root compression.…”

“…1,2 Substantial quantities of blood may be required during its management which, given the need for blood conservation, has led to recommendations by several bodies for the use of red cell salvage. [3][4][5] Cell salvage in obstetrics has increased dramatically in the last decade. 6 However, there is a lack of evidence for its use in terms of economic justification or transfusion reduction.…”

Interscapular pain associated with neuraxial labour analgesia: a case series

“…In 1993, Shah et al measured epidural space pressures in 17 parturients undergoing epidural saline infusion for prophylactic treatment of post-dural puncture headache after unintentional dural puncture. 2 In that study, four of the 17 patients developed interscapular pain that was associated with a higher epidural pressure than those who did not develop interscapular pain during the epidural saline infusion. In two of these four patients, an improvement in their symptoms occurred when the epidural saline infusion was slowed and a lower epidural space pressure was measured.…”

Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal

“…1 Intolerance to epidural infusions has been reported; typically, upper back (interscapular), neck, and sometimes shoulder pain occur after high-volume infusions for prolonged periods. 2, 3 We describe a case of a parturient who experienced severe upper back and neck pain after receiving only a very small volume of epidural medication because of congenital short pedicle syndrome and accompanying severe spinal stenosis. 4 …”