///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

A Walking Epidural for Labor Analgesia in a 624 Pound Primigravida: Yes, She Walked!

Abstract Number: 194
Abstract Type: Case Report/Case Series

Lisa M Councilman MD1

Introduction: We present the case of a 624 pound (#) primigravida who received a walking epidural for labor analgesia and subsequently ambulated successfully, theoretically reducing her risk of serious complications from immobilization during labor due to her super morbid obesity.

Case: A 35-year-old, 55" 624# (BMI 103) primigravida was hospitalized at 32 weeks gestation for severe preeclampsia. Anesthetic evaluation was performed and patient requested a walking epidural for labor, a technique she had read about on the internet. Labor induction was instituted, but fetal heart rate monitoring was difficult due to the patients size. The obstetricians requested epidural analgesia for examination, rupture of membranes, and placement of an intrauterine pressure catheter and fetal scalp electrode for monitoring, to be performed in the operating room with a double set-up prepared for emergent cesarean section (C/S) if needed. Following multiple unsuccessful attempts to locate the spinous processes using ultrasound, a blind anatomical approach was used to enter the epidural space on first attempt using a six-inch Tuohy needle. The loss of resistance was felt at a depth of 10 centimeters. Epidural catheter was successfully placed, secured, and epidural analgesia was initiated with 8 ml of 0.125% bupivacaine and fentanyl 100 mcg. The obstetric exam and procedures were performed with no discomfort felt by the patient. After completion of the procedure, the patients motor strength in her lower extremities was evaluated and felt to be adequate for walking. The patient requested to walk back to her room from the operating room and did so without event after making several rounds around the labor and delivery unit. Once the patient was in active labor, an infusion of bupivacaine 0.125% was initiated and continued until a C/S was required for failure to progress.

Discussion: Labor analgesia in the super morbidly obese parturient presents many challenges, both obstetric and anesthetic. Technically, placement of neuraxial catheters is difficult, as anatomy is distorted. Prevention of complications associated with prolonged immobilization in the super morbidly obese patient, such as deep vein thrombosis and pulmonary embolus, is of critical importance. Tailoring the anesthetic technique to minimize immobilization should theoretically reduce the incidence of these potentially devastating complications.

SOAP 2010