title: Labour pain management in a parturient with an implanted intrathecal pump.
abstract: OBJECTIVE
  We report the peripartum anaesthetic management for vaginal delivery of a chronic pain patient with an implanted intrathecal pump. This is the first report describing labour analgesia in a patient with such a device. As intrathecal systems become more popular for the management of nonmalignant pain, this situation is likely to be encountered with increasing frequency in the future.
  
  
  METHODS
  The patient was a nulliparous 23-yr-old with a history of chronic hereditary pancreatitis whose intractable pain had been managed with intrathecal morphine 3 mg.day-1 via an implantable pump for four years. Inadequate time between presentation and onset of labour prevented us from using this system. Intravenous patient controlled analgesia with fentanyl using a bolus of 25 micrograms and a lockout of five minutes was ineffective and epidural analgesia using bupivacaine was initiated and resulted in satisfactory analgesia.
  
  
  CONCLUSIONS
  The presence of an existing intrathecal delivery system does not preclude the use of supplemental epidural analgesia during labour.
authors.affiliation: Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tarshis
authors.forename: J E
authors.initials: JE
authors.lastname: Zuckerman
authors.forename: N P
authors.initials: NP
authors.lastname: Katz
authors.forename: S
authors.initials: S
authors.lastname: Segal
authors.forename: P S
authors.initials: PS
authors.lastname: Mushlin
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010148:Intractable Pain / Q000150:complications* / Q000209:etiology; D010195:Pancreatitis / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications; D012600:Scoliosis / Q000150:complications
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine