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Labor Management of a Parturient with an Existing Intrathecal Opioid Pump: A Case Report
Abstract Number: RF3BC-515
Abstract Type: Case Report Case Series
Intrathecal pump (ITP) therapy has been utilized in chronic pain patients since the early nineties. Pregnancy in patients with ITP is not a common occurrence. The majority of reported cases are baclofen pumps for spasticity. There are only two case reports of pregnancy and labor management in patients with opioid ITP [1,2]. This case report discusses the anesthetic management of a parturient with a hydromorphone ITP which was in place for treatment of complex regional pain syndrome (CRPS).
A 27 yo G1 with a past medical history of anxiety, dyslexia, PTSD, high-functioning autism spectrum disorder and CRPS Type I due to congenital hemivertebra kyphoscoliosis presented at 34 weeks for an acute exacerbation of chronic lower back and leg pain. Her chronic pain was managed with an ITP placed at an outside hospital containing hydromorphone with recent dose escalation to 1.75 mg/day. Chronic pain management was consulted to assist in optimizing her pain regimen without further increasing the dose. Cyclobenzaprine, acetaminophen, and alternating topical lidocaine and capsaicin were recommended. Trigger point injections to her thoracic and lumbar paraspinal muscles were also performed for myofascial pain. This regimen allowed her pain to return to baseline. At 37 weeks and 5 days, she went into spontaneous labor but required a cesarean delivery for non-reassuring fetal heart rate tracings. A combined spinal epidural was successfully placed with 13.5 mg of bupivacaine and 20 mcg of fentanyl. There were no complications for her and her baby. She was discharged home on POD#3 after meeting postpartum goals.
Neuraxial anesthesia can be safely used in parturients with ITP. Parturients with ITP should be discussed with pain management providers, anesthesiologists and obstetricians to ensure effective neuraxial analgesia or anesthesia if desired.
1. Tarshis J. Labour pain management in a parturient with an implanted intrathecal pump”. Can J Anaesth. 1997; 44(12):1278-81. doi: 10.1007/BF03012776.
2. Moron, Antonio F. “Complex Regional Pain Syndrome and Pregnancy.” Clinical Obstetrics, Gynecology and Reproductive Medicine, 7 Apr. 2017, doi:10.15761/COGRM.1000177.