title: Prior lumbar discectomy surgery does not alter the efficacy of neuraxial labor analgesia.
abstract: BACKGROUND
  Lumbar discectomy surgery is a common neurosurgical procedure. Neuraxial labor analgesia may be less effective in parturients with a history of discectomy surgery because of postsurgical scarring and anatomical distortion. In this prospective observational case-controlled study, we compared bupivacaine consumption per hour of labor analgesia as an indirect measure of labor analgesic effectiveness between women with prior discectomy surgery and those who did not have back surgery.
  
  
  METHODS
  All women with prior discectomy surgery who requested neuraxial labor analgesia at a high-volume, single university-affiliated women's hospital during the study period were approached. Control subjects were matched for anesthesiologist skill level. The primary outcome was bupivacaine consumption per hour of labor analgesia. Characteristics associated with the epidural catheter placement including the number of interspaces attempted, time to placement, and number of epidural catheters replaced for inadequate analgesia were recorded. Subject characteristics, labor outcomes, and analgesia outcomes were analyzed using the Wilcoxon ranked sum or Fisher exact test. Epidural placement data were analyzed using the Wilcoxon signed rank, McNemar's, or sign test.
  
  
  RESULTS
  Data were analyzed for 42 women in the discectomy group and 42 women in the control group. Bupivacaine consumption per hour of labor analgesia was not different between groups (median [interquartile range, IQR]: discectomy 12.7 mg/h [11.0 to 15.3] and control 13.2 mg/h [11.3 to 15.7]; difference in medians [95% confidence interval, CI]: -0.55 mg/h [-1.33 to 1.39]; P = 0.43). The interval from initiation of neuraxial analgesia and delivery and mode of delivery did not differ between groups. The median difference (95% CI) in the time to place the epidural catheter between the discectomy and control subjects was 0 minute (-1 to 2.5); P = 0.38. More than 1 interspace was attempted in 17% discectomy in comparison with 2% of the control subjects-difference (95% CI) 15% (2-26); P = 0.03. The neuraxial technique and estimated level of catheter placement did not differ. Completion of the procedure by a more senior anesthesiologist occurred in 3 discectomy subjects and 2 control subjects (P = 1.0). No epidural catheters were replaced.
  
  
  CONCLUSIONS
  There was no difference in hourly bupivacaine consumption in parturients with prior lumbar discectomy surgery undergoing neuraxial labor analgesia in comparison with controls. Time to placement of the epidural catheter was not different either, but more interspaces were attempted in the discectomy group. Our findings suggest that standard clinical neuraxial analgesic methods are effective in women with discectomy surgery.
authors.affiliation: Department of Anesthesiology, Northwestern University, 250 East Huron F5-704, Chicago, IL 60611, USA. jbauchat@gmail.com
authors.forename: Jeanette R
authors.initials: JR
authors.lastname: Bauchat
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Koski
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cambic
authors.forename: Amy I
authors.initials: AI
authors.lastname: Lee
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Wong
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D016022:Case-Control Studies; D002641:Chicago; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D048949:Labor Pain / Q000175:diagnosis / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000601:surgery*; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine