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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

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

Dr Natesan Manimekalai MD1 ; Dr Izabela Wasiluk MD2; Charlene Williams MS3; Dr Varun Rimmalapudi MD4; Dr Anita Vinjirayer MD5

Introduction:

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 patient’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.

Discussion:

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.

Conclusion:

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.

References

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-Barré patient. Anesth Analg 2004; 98:825-7

SOAP 2013