Unusual pain during cesarean section under epidural anesthesia and referred pain
Abstract Number: 221
Abstract Type: Case Report/Case Series
Many cesarean sections are conducted under epidural anesthesia for patients that have been labouring and then require an operative delivery. Epidural top up is a safe and effective way to provide anesthesia to the patient for operative delivery, however, adequate anesthesia must be achieved to ensure a successful outcome and patient comfort. Inability to achieve adequate analgesia for the patient often necessitates converting to a general anesthetic which increases the risk to mother and fetus. We report a case of a patient that experienced mid scapular pain during cesarean section despite an adequate epidural block that was checked with ice. The patient was uncomfortable with the pain despite the addition of epidural fentanyl and morphine. The pain experienced by the patient was immediately relieved with delivery of the fetus. A healthy baby boy was delivered with normal apgar scores and the mother did not experience any more episodes of the midscapular pain. There is no report in the current literature of such an occurrence and we speculate that this was caused by referred pain secondary to the position of the fetus in utero. This case demonstrates that pain during epidural anesthesia does not always indicate failure of the epidural technique and does not always necessitate conversion to a general anesthetic.