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Can a parturient with transverse myelitis and chronic pain syndrome be managed with labor epidural?
Abstract Number: T 66
Abstract Type: Case Report/Case Series
Transverse Myelitis (TM) is an acute or sub-acute inflammation of spinal cord resulting in motor, sensory and autonomic dysfunction. Since several cases of transverse myelitis have been reported following epidural and spinal anesthesia, regional anesthesia is denied in patients with acute or evolving TM . We present a successful use of labor epidural analgesia for spontaneous vaginal delivery, in a parturient sub-acute transverse myelitis with chronic pain syndrome, without worsening of any neurological deficit.
Case Description & Management
A 32 year old G2P1 with sub-acute transverse myelitis at 39 weeks of gestation was admitted for induction of labor.
Eleven months prior to this admission, the patient had fever and chills for 2 days, developed numbness in both lower extremities, which progressed to weakness and inability to walk, besides having fecal & urinary incontinence. The diagnosis of transverse myelitis at T8 level was confirmed by MRI and CSF analysis. The patient was admitted to ICU, treated with high dose steroid and the symptoms were slowly improved. She was discharged home after 4 weeks.
During the current admission, her neurological examination was normal except chronic pain syndrome and neurogenic bladder, for which she used self-catheterization. After induction of labor, epidural was placed due to intolerable pain. Since the patient required frequent epidural boluses to control her pain, higher concentration of local anesthetic was infused. She delivered a healthy baby without any autonomic instability or neurological deficit and was discharged home on 3rd post partum day.
Transverse myelitis is very rare in the obstetric population and only eight cases of parturient with TM have been reported in literature so far . Regional anesthesia is not only prevents autonomic hyper-reflexia but also provides good pain relief in parturient with transverse myelitis. Despite concerns surrounding neuraxial anesthesia and onset of transverse myelitis, we successfully used epidural analgesia in a parturient with transverse myelitis without any new or worsening neurological deficit.
Because of paucity of literature evidence describing the use of regional anesthesia in patients with TM, publishing this case report will further augment documented clinical evidence and create confidence in managing such rare cases.
1. Jung Ho Seok, Youn Hee Lim, Seung Hoon Woo, and Jun Heum Yon. Transverse myelitis following
combined spinal-epidural anesthesia. Korean J Anesthesiol 2012 November 63(5): 473-474
2. Thomas S, Massey S, Douglas J, Magee L, Rosengarten M. Obstetric anaesthesia and transverse
myelitis. Int J Obstet Anesth. 2010 Oct; 19(4):467-8