Epidural analgesia in parturients with previous spinal irradiation.
OBJECTIVE
To present two successful cases of labour analgesia in patients who had been treated with radiation to the lumbar spine for neuroblastomas and to discuss the considerations when planning the anaesthetic management of these patients.


METHODS
We recently encountered two primigravidas requesting labour analgesia, both of whom were noted to have very thin backs with prominent spinous processes and obvious scoliosis. In both patients, the epidural space was easily identified and very shallow. Successful labour analgesia was achieved in both patients, one with a combined spinal epidural technique and the other with an epidural catheter.


CONCLUSIONS
Craniospinal irradiation is known to have long-term effects on exposed nervous tissue, bone, and blood vessels. While a larger experience is necessary to demonstrate safety of regional anaesthesia in parturients following previous spinal irradiation, we provide reports of two successful cases.
Hilton
A B
AB
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Lockhart
E M
EM
Penning
D H
DH
D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000295:instrumentation / Q000379:methods; D016362:Analgesia, Obstetrical / Q000295:instrumentation / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008159:Lumbar Vertebrae / Q000528:radiation effects*; D009447:Neuroblastoma / Q000532:radiotherapy*; D010347:Patient Care Planning; D011247:Pregnancy; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D012600:Scoliosis / Q000150:complications; D013129:Spinal Puncture / Q000295:instrumentation / Q000379:methods
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine