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Efficacy of Neuraxial Analgesia for Labor in Women with a History of Surgical Correction for Scoliosis: A Prospective Observational Study
Abstract Number: F-23
Abstract Type: Original Research
Introduction: Data on neuraxial labor analgesia failure rates in women with surgical correction for scoliosis range from 6-50% and are pooled from case reports and retrospective series.1-5 We performed a prospective observational study evaluating analgesic efficacy of combined spinal-epidural (CSE) or traditional epidural techniques in laboring women with spinal instrumentation for scoliosis repair. We hypothesized that women with prior spinal instrumentation (SI) would require more epidural bupivacaine to attain effective analgesia than case-matched controls (CONT).
Methods: In this case-matched cohort study, 41 SI and 41 CONT subjects were needed to detect a difference of bupivacaine consumption 2.2 mg/h of labor analgesia. The CONT subject was case-matched for anesthesia provider and recruited after neuraxial placement in the SI subject. At the anesthesiologist’s discretion, analgesia was initiated with CSE or epidural technique and maintained with patient controlled epidural analgesia with bupivacaine 0.625%/fentanyl 2 µg/mL (bolus 5 mL q10 min, basal rate 15 mL/h). For supplemental analgesia, bupivacaine 0.125% (15 mL) was given and the infusion changed to bupivacaine 0.11%/fentanyl 2 µg/mL. Secondary outcomes included: switching to a more experienced provider, needle redirections and interspaces attempted, supplemental analgesia, analgesic failures and complications. Groups were compared using χ2 or Mann-Whitney U tests. P < 0.05 was significant.
Results: Data were evaluated for 82 patients. Gravida, parity, BMI, time to delivery and mode of delivery were not different between groups. There was no difference in bupivacaine consumption (SI 16.0 mg/h vs. CONT 15.2 mg/h, median difference 0.9 (95% CI -1.4 to 2.9)(P=0.43)) or supplemental analgesia requirements. The number of redirections, interspaces attempted and time to placement were longer in the SI group; 5 cases in the SI group and 0 in the CONT group required a more experienced provider due to difficult placement or analgesic failure (P=0.01). There was one dural puncture in the SI group. (Table)
Conclusions: Women with spinal instrumentation for scoliosis repair have equivalent hourly bupivacaine consumption as those without prior back surgery for neuraxial labor analgesia; however, the neuraxial procedure is technically more difficult.
1) Anesth Analg 2009;109:1930-4
2) Reg Anesth 1990;15:280-4
3) Can J Anaesth 1989;36:693-6
4) Ann Fr Anesth Reanim 2003;22:91-5
5) Int J Obstet Anesth 2003;1