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Dural puncture epidural for caesarean delivery in a parturient with multiple sclerosis

Dural puncture epidural for caesarean delivery in a parturient with multiple sclerosis A 30‐year‐old woman with a history of multiple sclerosis (MS) presented for elective caesarean delivery. Her MS had relapsed during the first trimester with right upper and lower limb sensory deficit, lower limb weakness and difficulty walking necessitating treatment with natalizumab. Her symptoms had resolved by the third trimester. She was referred for anaesthesia assessment prior to her planned caesarean delivery, where she expressed a strong desire to be awake for childbirth.A dural puncture epidural (DPE) was performed for this patient: Following insertion of a Touhy needle into the epidural space at the L4–L5 interspace, a dural puncture was undertaken by needle through needle passage of a 27G pencil‐point spinal needle. Clear cerebrospinal fluid was observed, but no medication was administered through the spinal needle. An epidural catheter was then inserted and test dose of 3 ml bupivacaine 0.5% was administered, followed by 8 ml lidocaine 2% and 8 ml bupivacaine 0.5%. Surgery proceeded after assessment of the block; the patient had no pain during the procedure with adequate sensory and motor blockade. She made an uneventful recovery with no recurrence of neurological symptoms.Epidural anaesthesia has traditionally been favoured for obstetric procedures in patients with MS and is felt to be a http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Dural puncture epidural for caesarean delivery in a parturient with multiple sclerosis

Sharapi, M.; Loughrey, J. P. R.
Anaesthesia Reports , Volume 10 (1) – Jan 1, 2022
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Publisher
Wiley
Copyright
2022 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12169
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Abstract

A 30‐year‐old woman with a history of multiple sclerosis (MS) presented for elective caesarean delivery. Her MS had relapsed during the first trimester with right upper and lower limb sensory deficit, lower limb weakness and difficulty walking necessitating treatment with natalizumab. Her symptoms had resolved by the third trimester. She was referred for anaesthesia assessment prior to her planned caesarean delivery, where she expressed a strong desire to be awake for childbirth.A dural puncture epidural (DPE) was performed for this patient: Following insertion of a Touhy needle into the epidural space at the L4–L5 interspace, a dural puncture was undertaken by needle through needle passage of a 27G pencil‐point spinal needle. Clear cerebrospinal fluid was observed, but no medication was administered through the spinal needle. An epidural catheter was then inserted and test dose of 3 ml bupivacaine 0.5% was administered, followed by 8 ml lidocaine 2% and 8 ml bupivacaine 0.5%. Surgery proceeded after assessment of the block; the patient had no pain during the procedure with adequate sensory and motor blockade. She made an uneventful recovery with no recurrence of neurological symptoms.Epidural anaesthesia has traditionally been favoured for obstetric procedures in patients with MS and is felt to be a

Journal

Anaesthesia Reports – Wiley

Published: Jan 1, 2022

Keywords: caesarean delivery; DPE; dural puncture epidural; epidural analgesia; multiple sclerosis; spinal anaesthesia

References

  • Dural puncture epidural technique improves labor analgesia quality with fewer side effects compared with epidural and combined spinal epidural techniques: a randomized clinical trial
    Chau, A; Bibbo, C; Huang, C‐C
  • Sensorimotor anesthesia and hypotension after subarachnoid block: combined spinal‐epidural versus single‐shot spinal technique
    Goy, RW‐L; Sia, AT‐H