Join now to get access to this content and more.
Become a SOAP member and have access to our benefits.
- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients
- Sample Centers of Excellence Applications
- ASA Corner
- SOAP Policy and Procedure Manual (P&P Manual)
- SOAP Expert Opinions
- SOAP's Learning Modules
- 2019 Annual Meeting Lecture Videos
- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar
- Submit a Position
- View Job Postings
- Previous Meeting Archives
- Previous Meeting Abstract Search
- CMS Guidelines
- Member Benefits
- Newsletter Clinical Articles
- ACOG Documents
- Search our Patient Safety Archive
- Ask SOAP a Question
- Global Health Opportunities
- And more…
Successful use of epidural analgesia for labor and delivery in a parturient with Guillain-Barre Syndrome
Abstract Number: F 63
Abstract Type: Case Report/Case Series
Guillain-Barre Syndrome (GBS) is an acute demyelinating polyneuropathy manifesting with progressive motor weakness and ascending paralysis. Due to the rarity of GBS during pregnancy, there are no established guidelines for the use of regional anesthesia and analgesia for labor or Caesarean delivery. We report a successful use of labor epidural analgesia in a parturient with resolving GBS without worsening of any neurological symptoms.
Case Description & Management:
A 32 yr old G3P2 parturient, had been admitted at 28 weeks of gestation with symptoms of weakness in both lower and upper extremities, progressing to inability to walk, bilateral facial paralysis, difficulty in swallowing and fecal & urinary incontinence. The diagnosis of GBS was confirmed by CSF analysis and nerve conduction studies showed mixed axonal and demyelinating neuropathy. She was transferred to ICU and treated with IV-Immunoglobulin. The patientâ€™s symptoms slowly improved and she was discharged home on day 28 with some residual weakness. In her 37th week of gestation, she was admitted to L&D in labor with residual numbness and tingling sensation in both feet and facial paresis. A decision was made to place labor epidural, which proceeded without complication and patient delivered a healthy female baby without worsening or relapse of any neurological symptom or autonomic instability. She was discharged home on the 3rd post-partum day.
Generally, it is perceived that patients with pre-existing neurologic disease may be at increased risk of subsequent neurologic injury and worsening of symptoms from neuraxial anesthesia and analgesia and are often denied epidural analgesia. Both epidural and spinal anesthesia and analgesia have been used successfully in a few cases with active or resolving GBS, though one case of worsening of neurologic symptoms after labor epidural anesthesia in a Guillain-Barre patient has been reported [1, 2]. Our patient did not have any new or deterioration of any existing neurological symptoms following epidural analgesia.
Since controversies exist in the use of regional anesthesia and analgesia in patients with active or resolving GBS, we believe that our experience of successful use of labor epidural in this parturient with resolving GBS without worsening of any neurological symptoms will add valuable information in literature for future reference.
1. Kocabas S, Karaman S, Firat V, Bademkiran F. Anesthetic management of Guillain-Barre syndrome in
pregnancy. J Clin Anesth. 2007 Jun; 19(4):299-302
2. Wiertlewski S, Magot A, Drapier S, Malinovsky JM, Pereon Y. Worsening of neurologic symptoms
after epidural anesthesia for labor in a Guillain-BarrĂ© patient. Anesth Analg 2004; 98:825-7