Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal.
Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.
From the *Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL; and †Ochsner Health System, New Orleans, LA.
David M
DM
Dickerson
Ran
R
Dai
Barbara M
BM
Scavone
William
W
McDade
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D001416:Back Pain / Q000209:etiology; D003251:Constriction, Pathologic; D036861:Delivery, Obstetric; D004824:Epidural Space / Q000002:abnormalities*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D013130:Spinal Stenosis