Interscapular pain associated with neuraxial labour analgesia: a case series

Klumpner, Thomas T.; Toledo, Paloma; Wong, Cynthia A.; Farrer, Jason

doi:10.1007/s12630-015-0540-7

Cited by 5 publications

(4 citation statements)

References 11 publications

(10 reference statements)

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“…Klumpner et al published a case series describing labor epidural analgesia-associated interscapular pain [3]. Their group reported several patients who received epidural analgesia for up to 19 hours and experienced intense interscapular pain associated with bolus doses.…”

Section: Discussionmentioning

confidence: 99%

“…Their group reported several patients who received epidural analgesia for up to 19 hours and experienced intense interscapular pain associated with bolus doses. The treatments described by the authors included increasing the epidural concentration of local anesthetic to reduce the volume delivered, administration of epidural fentanyl, and even replacement of the epidural catheter [3]. The use of epidural clonidine was not described in their report.…”

Section: Discussionmentioning

confidence: 99%

“…The COMET study group showed a 23% reduction in the incidence of operative vaginal delivery (e.g., forceps delivery) when dilute solutions are used compared to concentrated labor epidural analgesia solutions. A reported consequence of dilute solutions is an increase in the volume of solution in a parturient's epidural space, which may lead to pressure-induced interscapular pain associated with bolus dosing of an epidural [2,3]. The use of clonidine as part of a treatment protocol has not been previously reported for treating labor epidural-analgesia-associated interscapular pain.…”

Section: Introductionmentioning

confidence: 99%

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Clonidine as an Adjunct for the Successful Treatment of Labor Epidural Infusion-Associated Interscapular Pain

Samworth¹,

DeLeon²,

Patel³

et al. 2023

Cureus

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Epidural infusion-associated interscapular pain for laboring parturients is a treatment dilemma for obstetric anesthesiologists. We report a case of a parturient who was successfully treated for labor epidural analgesiaassociated interscapular pain. Our treatment plan included reducing the volume of local anesthetic administered by adding the adjunct of clonidine, increasing the epidural solution concentration of local anesthetic, and reducing the overall infusion rate. We conclude that epidural clonidine should be considered a safe adjunct when treating laboring parturients who report epidural infusion-associated interscapular pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clonidine as an Adjunct for the Successful Treatment of Labor Epidural Infusion-Associated Interscapular Pain

Samworth¹,

DeLeon²,

Patel³

et al. 2023

Cureus

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“…2 Similarly, some patients who received epidural saline at high rates for long periods for treatment of postdural puncture headache complain of severe upper back interscapular pain. 3 In these reports, MRI findings were not documented.…”

Section: Discussionmentioning

confidence: 99%

Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal

Dickerson

Dai

Scavone

et al. 2016

Regional Anesthesia and Pain Medicine

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Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.

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2016

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Interscapular pain associated with neuraxial labour analgesia: a case series

Cited by 5 publications

References 11 publications

Clonidine as an Adjunct for the Successful Treatment of Labor Epidural Infusion-Associated Interscapular Pain

Clonidine as an Adjunct for the Successful Treatment of Labor Epidural Infusion-Associated Interscapular Pain

Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal

Multiple drugs

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