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

Utilizing Skin Temperature Measurements to Assess Efficacy of Epidural Analgesia in a T6 Paraplegic Parturient.

Abstract Number: S 69
Abstract Type: Case Report/Case Series

Robert F. Olszewski B.S., M.D.1 ; Jaime L. Baratta M.D.2

We present a patient with autonomic hyperreflexia (AH) in which a novel method of measuring the level of epidural blockade was employed. AH is a life-threatening condition that occurs commonly in patients with spinal cord injury at or above the T7 level (1). AH is characterized by facial flushing, bradycardia, and malignant hypertension (4). It is precipitated by stimulus below the level of injury or distention of hollow viscera, i.e. bladder distention, uterine contraction, or cervical dilation (2). Prophylactic epidural analgesia is the treatment of choice for AH, however assessment of the level of analgesia is difficult in these patients due to their injury.

A 23-year-old P1G0 with T4 parapalegia and AH presented at 37 weeks EGA for management of delivery by induction of labor. The plan included epidural prior to labor induction as prophylaxis against AH triggered by uterine contraction. An epidural catheter was placed at the L3/L4 interspace with 6cm of catheter in the epidural space. Analgesia was induced with bupivacaine 0.25%. An infusion of 0.1% bupivacaine with 1.5 mcg/mL fentanyl was initiated at 10 mL/hr. Skin temperature probes were placed at the T8 and L5 levels to asses temperature change due to vasodilation caused by the epidural block. Readings were taken at 5 minute intervals during the dosing of the epidural medication. During this time, an increase in skin temperature was noted that the T8 and L5 Levels. Following completion of dosing, a control temperature was taken at the C4 level which was lower from the T8 level temperature. Labor proceeded without incident and the catheter was removed following delivery.

Prophylaxis against the trigger of AH is an important aspect of the management of at-risk patients who present for childbirth. Placement of an epidural is the current standard for treating these patients (3). Difficulty arises in the dosing of the epidural block in patients who are unable to communicate the signs of loss of cold or sharp touch sensation for the assessment of block level,(3) as in pediatrics or otherwise non-communicative patients. We propose that increase in skin temperature at the desired level of block can be studied as a potential simple and safe measure of blockade in patients who are otherwise unable to communicate block level.

1. Miller, R. Miller’s Anesthesia 7th ed. 2009.

2. Anes. Analg. 89(1):148-9, 1999 Jul.

3. Regional Anesthesia. 19(6):415-7, 1994 Nov-Dec.

4. Anesthesiology. 51(6):560-2, 1979 Dec.

SOAP 2013