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Combined spinal and epidural analgesia for labor in a patient with Charcot-Marie-Tooth disease
Abstract Number: 176
Abstract Type: Case Report/Case Series
Charcot-Marie-Tooth (CMT) disease is a rare hereditary sensorimotor neuropathy, characterized by loss of muscle tissue and touch sensation. It can pose challenge for anesthetic intervention due to affected respiratory muscles and vertebral anatomy. Use of neuraxial anesthesia has been reported in parturient with CMTD, but the use of combined spinal epidural analgesia (CSE) has not been reported. Here we present a patient with CMT disease who received CSE for labor analgesia with no adverse outcome.
Patient was a 29-year-old primipara, admitted after onset of labor. She has had troubling walking and foot drops since thirteen. Neurological examination revealed that she had pes cavus on both feet with no motor, sensory or reflex deficits. Diagnosis of CMT type II was made after nerve conduction studies and muscle biopsy. This pregnancy has been uneventful. She requested labor epidural after 9 hours into labor. After discussion with her the risks and benefits of the procedure, we performed combined spinal and epidural analgesia successfully. She received 2ml of 0.1% ropavacine + fentanyl 2mcg/ml intrathecally; catheter was threaded 5 cm into epidural space. After negative test dose testing, she was started on PCEA with continuous epidural infusion. Excellent analgesia was obtained; 18 hours later, she was brought to OR for urgent C-section secondary to failure to progress. She received 3% chloroprocaine 20ml epidurally. Baby was born 18 minutes after skin incision; Apgar score 9 /9. She was continued with epidural infusion for post operative pain control. Catheter was removed on post operative day 1. She was ambulating and tolerating PO intake. There were no neurological deficits noted. She was discharged home on day 3 post surgery and will be followed up at neurology clinic regularly.
Charcot-Marie-Tooth-Disease is a slowly progressive neuropathy with potential of exacerbation during pregnancy. Use of neuraxial blockade for labor analgesia is not without concern, especially for fear of litigation should exacerbation occur. We successfully performed CSE on a parturient with CMT disease for labor analgesia, which has not been previously reported. We believe it is one of the labor pain management regimens that a parturient with CMT could benefit from.
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