Table 4 Management of anesthesia for vaginal delivery in challenging cases
From: Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study
Case | Age | History of pregnancy (para) | Clinical diagnoses | Neurological findings and symptoms | Planned anesthesia | Switch to alternative plan | Consequence |
|---|---|---|---|---|---|---|---|
1 | 34 | 0 | AIS, obesity BMI (35.7) | Difficult palpitation. T7–T11 thoracic Cobb angle 43°. T11-L4 thoracolumbar Cobb angle 41° | EDB | NA | EDB at L3/4 after multiple attempts |
2 | 33 | 0 | LDH | Narrow intrathecal space at L4/5. Pain in the back of the right thigh and calf | DPE | EDB | CSF not obtained w/DPE. Sufficient analgesia w/EDB |
3 | 36 | 1 | Spina bifida | Postoperative change at Th12-L1. Intact epidural space below L2. Sensory loss below Th12/L1, with preserved deep sensation but impaired temperature and pain perception | CSEA below L2/3 | CSEA at L4/5 | Difficult EDB at L3/4. Sufficient analgesia w/CSEA |
4 | 32 | 0 | AIS | Postoperative instrumentation at Th3-L2 | CSEA at L3/4 | EBD at L3/4 | No cold loss above Th12. But patient satisfied with receiving labor analgesia |
5 | 40 | 0 | LDH | Narrow intrathecal space at L5/S1. Previous numbness and pain at right big toe. Pain in the lower right back | EDB at L3/4 | Redo CSEA at L4/5 | Poor spread below L5 with EDB. Sufficient analgesia after CSEA |
6 | 32 | 0 | Tethered cord syndrome | Conus medullaris terminates at inferior border of L4 vertebral body. Tarlov cyst at sacral area. Low back pain | EDB at L2/3 | EDB replacement. Additional pudendal nerve block | Severe pain during the second stage of labor. Not fully relieved by alternative blocks |