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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Obstetric Anesthesia for Bone Marrow Edema Syndrome of Pregnancy: A Case Report.

Abstract Number: S5C-4
Abstract Type: Case Report/Case Series

Alexa Kaminski MD1 ; Nwamaka Nnamani MD2

A 36-year-old G3P2 Hispanic female with no PMH except class I obesity presented with bilateral knee pain at 8 weeks gestation. By the third trimester she had limited mobility and was wheel chair bound. X-ray and MRI were suggestive of bone marrow syndrome of pregnancy. She was placed on SQ heparin BID, Vitamin D, calcium citrate, calcitonin nasal spray, gabapentin, lidocaine topical patches, tramadol and hydrocodone/acetaminophen. The patient had 2 prior SVDs without anesthesia or analgesia. Obstetric anesthesia was consulted at 36 weeks gestation due to the high-risk nature of her pregnancy.

At 38 weeks gestation, labor was induced and she had an uneventful L3-L4 epidural placement. We utilized our conventional epidural infusion of fentanyl-0.0625% bupivacaine, delivered via PIEB mode every 50 minutes with PCEA capability. During her 10 hour labor, she did not require any additional boluses or interventions via her epidural. Her pain and mobility improved for a few days post-delivery. The patient remained hospitalized for 1 week postpartum to engage in physical and occupational therapy.

Bone marrow edema syndrome, interchangeably classified as transient osteoporosis, is a rare, self-limiting condition that presents with disabling joint pain without a traumatic or inciting event (1). It primarily affects women in the third trimester of pregnancy, but may occur in non-pregnant women and more commonly, middle-aged men (2). It is best diagnosed with MRI, as bone marrow edema is demonstrated within the bone as early as 48 hrs from onset of symptoms (3). The hip joint is the most frequently affected, followed by the knee and ankle joints (2). The cause, pathogenesis and treatment of this disorder during pregnancy are uncertain and unclear (1,2). Given the rarity of this condition, little is known about the anesthetic management in pregnancy. Our anesthetic care with a labor epidural played a vital role for pain control during delivery and for post-partum mobility.

1. Knee Surg Sports Traumatol Arthrosc. 2009;17:1061-1064.

2. Turk J Phys Med Rehab. 2016;62(2):178-181.

3. Osteoporos Int. 2017;28:1805-1816.

SOAP 2018