Epidural analgesia for acute symphysis pubis dysfunction in the second trimester.
We report a case of severe symphysis pubis dysfunction in a parturient during her second trimester of a twin pregnancy. Symphysis pubis dysfunction produces pain, instability and limitation of mobility and function, of the symphysis pubis during pregnancy and labour. It is often under-treated. We provided lumbar epidural analgesia with intermittent top-ups of bupivacaine 0.1% with fentanyl 2 micrograms/mL for 72 h. This provided initial analgesia, breaking a vicious cycle of pain and muscle spasm. The benefits extended into the remainder of her pregnancy. Subsequently, simple analgesics and physiotherapy allowed control of pain until vaginal delivery 15 weeks later.
Department of Anaesthesia, Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK.
J K
JK
Scicluna
J D
JD
Alderson
V J
VJ
Webster
P
P
Whiting
D000328:Adult; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011262:Pregnancy Trimester, Second; D011631:Pubic Symphysis; D013035:Spasm / Q000188:drug therapy* / Q000209:etiology; D014427:Twins
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine