title: Labor Analgesia Consumption and Time to Neuraxial Catheter Placement in Women with a History of Surgical Correction for Scoliosis: A Case-Matched Study.
abstract: BACKGROUND
  Neuraxial analgesic techniques are the most effective form of labor analgesia. Small studies (9-21 patients), conducted 10 to 20 years ago, demonstrated successful neuraxial labor analgesia in only 50% to 66% of patients with surgical correction for scoliosis. Newer surgical techniques for scoliosis correction make the epidural space more accessible, but postsurgical changes may still alter the efficacy of neuraxial labor analgesia. The purpose of this prospective case-matched study was to compare hourly bupivacaine consumption and time to placement of neuraxial technique in laboring women with spinal instrumentation compared with women without previous back surgery.
  
  
  METHODS
  All women with previous spinal instrumentation surgery for scoliosis correction who requested neuraxial labor analgesia at Prentice Women's Hospital during the study period were approached. Control subjects were matched for anesthesiologist level of experience. The primary outcomes were bupivacaine consumption per hour of labor analgesia and time to placement of the neuraxial technique. Secondary outcomes included supplemental analgesia requirements and neuraxial analgesia failures and complications.
  
  
  RESULTS
  Data from 41 women with surgical correction for scoliosis and 41 control subjects requesting neuraxial labor analgesia were analyzed. Obstetric and demographic characteristics of study participants were not different between groups. Median (interquartile range) hourly bupivacaine consumption was 15.2 mg/h (12.5-18.7) in the spinal instrumentation group and 14.2 mg/h (11.8-16.0) in the control group; the difference in medians was 1 mg/h (95% confidence interval [CI], -1.3 to 3.0; P = 0.38). The total bupivacaine consumption, number of manual reboluses, and number of subjects requiring greater bupivacaine concentrations did not differ between groups. Neuraxial analgesia failure occurred in 5 (12%) of women in the spinal instrumentation group but in none of the control patients (difference [95% CI], 12% [-0.3% to 25%]; P = 0.06). The mean time required to complete the neuraxial technique was 41% (95% CI, 7%-108%; P = 0.01) longer in the spinal instrumentation group than in the control group. The spinal instrumentation group also required a greater number of needle redirections, attempted interspaces, and need to switch to a more experienced provider than matched controls.
  
  
  CONCLUSIONS
  The findings of this investigation suggest that previous surgery for scoliosis repair does not affect neuraxial labor analgesia consumption, but performance of the neuraxial technique is more difficult. Our findings suggest that neuraxial labor analgesia should be offered to parturients with previous surgery for scoliosis repair although informed consent should include a discussion of the possibility of technical difficulties and surgical anesthesia failure.
authors: From the Department of Anesthesiology, Northwestern University, Chicago, Illinois; and Department of Neurological Surgery, Northwestern University, Chicago, Illinois.
authors: Jeanette R
authors: JR
authors: Bauchat
authors: Robert J
authors: RJ
authors: McCarthy
authors: Tyler R
authors: TR
authors: Koski
authors: Cynthia A
authors: CA
authors: Wong
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D059408:Pain Management / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013997:Time Factors