///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-06:00

Ultrasound Guidance for Epidural Placement in a Patient With Posterior Spinal Fusion

Abstract Number: SUN-16
Abstract Type: Case Report/Case Series

Garrett Russell M.D.1 ; Neil Kalariya M.D.2; Tracey Vogel M.D.3

Introduction: Epidurals have been used as a form of labor analgesia for over 50 years. There have been few studies on the placement and efficacy of epidurals in women with a history of scoliosis corrected by spinal fusion. We report a case on the use of ultrasound for epidural placement in a patient with corrected scoliosis.

Case Report: A 27-year-old G1P0 with a history of idiopathic thoracolumbar scoliosis status post spinal fusion from T3-L4 at 16 years old presented with ROM at 39 weeks and requested an epidural. She reported no complications following her fusion and no longer follows with an orthopedist. On exam, a midline scar was present and spinous processes could be felt with mild scoliosis. The decision was made to proceed with an ultrasound guided epidural. A transverse approach was used to identify the location of the spinous processes, the optimal needle puncture site and angle for insertion, and the estimated depth of the epidural space. After identification of structures, an epidural was placed at the L4-5 interspace on the first attempt. The epidural with 0.1% Ropivacaine and Fentanyl 2mcg/mL was set to a rate of 10mL/hr. Pain scores with contractions decreased from 8/10 to 2/10 after 20 minutes, and a bilateral T10 level was present. She later delivered and the catheter was removed without difficulty. On post-delivery day 1 she reported no sensory or motor deficits, and was later discharged without complication.

Discussion: Epidurals were first reported in the 1940’s, gaining momentum soon after. Advantages of epidurals include pain control during the first and second stages of labor, and the ability to provide analgesia for a cesarean section. Scoliosis commonly complicates placement, and is four times more common in females with an incidence of 2%. The operative and instrumental delivery rate is 2.5 times higher compared to women without scoliosis. Therefore, there is a need for regional technique to avoid the risks of general anesthesia. Studies have shown two-thirds of patients with corrected scoliosis have undergone successful neuraxial analgesia for labor. Other studies have shown using ultrasound for pre-procedural guidance in those with scoliosis led to fewer failed epidurals, needle passes, and interspaces attempted. This case demonstrated ultrasound guidance as being effective for epidural placement in patients with corrected scoliosis, and further research is suggested to establish its effectiveness in other situations of difficult epidural placement.

References:

1. Chin, K., Perlas, A. Ultrasonography of the Lumbar Spine for Neuraxial and Lumbar Plexus Blocks. Current Opinion in Anesthesiology. 2011, 67-72.

2. Ko, J., Leffert, L. Clinical Implications of Neuraxial Anesthesia in the Parturient with Scoliosis. Anesthesia and Analgesia. 2009, 30-34.

3. Smith, P., et al. Regional Blockade for Delivery in Women with Scoliosis or Previous Spinal Surgery. International Journal of Obstetric Anesthesia. 2003, 17-22.

SOAP 2017