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Labour epidural in a mother with Hansen’s disease
Abstract Number: S-33
Abstract Type: Case Report/Case Series
Hansen’s disease or leprosy is a rare chronic systemic infection causing severe peripheral neuropathy. This systemic disease poses a challenge to the anaesthetists, not only because of the effects it has on the multiorgan systems, but also the lack of awareness of the effects it has on the parturient. There is a lack of hard data relevant to current practice in the western world especially in obstetric patients (1)
We present a 26-year-old primip originating from Sri Lanka who was admitted to labour ward at a 39 weeks gestation. She requested epidural for labour analgesia. She had been diagnosed with tuberculoid leprosy 3 years previously treated with multibacillary drug therapy (MDT). On presentation in labour she had multiple hypopigmented patches, severe peripheral neuropathy resulting in peripheral paraesthesia and a claw hand deformity. Vital sign were stable. Her blood results include a haemoglobin of 15.5g/dL, white cell count of 7.6 x 10 9/ L, platelets of 154 x10 9 and normal clotting screen. An epidural was performed using a full septic technique, a single insertion and otherwise uneventful. A slow top up dose in sitting position using 10ml of 0.1% bupivicaine + 2mcg/ml fentanyl was given. The test dose revealed no adverse signs after five minutes so a further 5 mls of local anaesthetic mix were given. She required one further top up 30 minutes later for adequate analgesia. On neurological examination approximately 1 hour following the second top up, she had complete sensory block to cold and touch between S1 to T4 bilaterally and bromage score of IV. She continued needing epidural top up intermittently in labour until spontaneous vaginal delivery 8 hours later. Following labour her sensory and motor function returned to normal after 3 hours. However she had urinary retention that required catheterization for 2 days.
The physiological immunosuppression of pregnancy can result in relapse even following MDT (1). Neuraxial block should be used cautiously due to the possibility of autonomic neuropathy, and urinary retention is a frequent problem. Neurological deficit can also follow after regional anaesthesia. We suspect our patient was demonstrating sensitivity of the C fibres which could be either due to the disease itself or its’ treatment. Awareness of the consequences of diseases once thought eradicated in the first world is important as a result of our shrinking world, and the obstetric anaesthetist must remain vigilant to this.
(1) Lockwood DN, Sinha HH. Pregnancy and leprosy: a comprehensive
literature review. Int J Lepr Other Mycobact Dis. 1999;67:6-12