Single dermatome analgesia sparing in an obstetric patient following previous radiation to that region.
We present a case of an obstetric patient with prior radiation therapy for Hodgkins lymphoma to the right hip, right flank region and lumbar spine, who suffered persistent right sided L1 dermatone distribution sensory and analgesia sparing after routine epidural placement despite additional boluses of local anesthetic. We postulate that the previous radiation therapy received by our patient left sufficient epidural fibrosis as a barrier to prevent spread of local anesthetic to cover the L1 dermatome. Subsequent replacement, using a combined spinal-epidural technique at a higher lumbar space, overcame this obstruction. In patients who have received substantial radiation therapy to the lumbosacral region in the past, awareness of this potential problem may assist in clinical management.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. mkpanni@zeus.bwh.harvard.edu
M K
MK
Panni
J M
JM
Anton
S
S
Segal