Labor Analgesia Consumption and Time to Neuraxial Catheter Placement in Women with a History of Surgical Correction for Scoliosis

Abstract

The findings of this investigation suggest that previous surgery for scoliosis repair does not affect neuraxial labor analgesia consumption, but performance of the neuraxial technique is more difficult. Our findings suggest that neuraxial labor analgesia should be offered to parturients with previous surgery for scoliosis repair although informed consent should include a discussion of the possibility of technical difficulties and surgical anesthesia failure.

Back Pain and Neuraxial Anesthesia

“…65 In a retrospective study of patients who had Harrington rod instrumentation, Crosby and Halpern 60 noted problems in placing the epidural catheter in 4 of 9 patients (Table 7). In the other retrospective study, 61 continuous lumbar epidural anesthesia was established in 20 of 21 attempts although excessive local anesthetic requirements were noted in 8 patients.…”

Obstetric Neuraxial Anesthesia Contraindicated? Really? Time to Rethink Old Dogma

“…However, many medical conditions that were deemed relative or absolute contraindications to the use of neuraxial anesthesia (often with minimal or no evidence) have now been shown to be compatible with safe neuraxial use. The findings reported in this issue of Anesthesia & Analgesia by Goodier et al 1 and Bauchat et al 3 are such examples. A cautious approach is always prudent.…”

“…So why were Bauchat et al 3 able to achieve such a high success rate in this challenging patient population when others have not? Perhaps they are just really good at what they do.…”

“…In this issue of Anesthesia & Analgesia, Bauchat et al 3 studied 41 women in labor with a history of surgical correction of scoliosis, in whom neuraxial analgesia was attempted. Some clinicians consider neuraxial anesthesia to be relatively or even absolutely contraindicated in these patients.…”

“…Previous reports indicate a success rate for neuraxial techniques of approximately 50% in this patient population. 4 Bauchat et al 3 The answer to the question "Can it be done?" is a resounding "yes," but it is usually more difficult than in a nonsurgically instrumented back.…”