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Labour pain management in a parturient with an implanted intrathecal pump

  • Jordan Tarshis
  • James E. Zuckerman
  • Nathaniel P. Katz
  • Scott Segal
  • Phillip S. Mushlin
Clinical Reports

Abstract

Purpose

We report the peripartum anaesthetic management for vaginal delivery of a chronic pain patient with an implanted intrathecal pump. This is the first report describing labour analgesia in a patient with such a device. As intrathecal systems become more popular for the management of nonmalignant pain, this situation is likely to be encountered with increasing frequency in the future.

Clinical features

The patient was a nulliparous 23-yr-old with a history of chronic hereditary pancreatitis whose intractable pain had been managed with intrathecal morphine 3 mg·day−1 via an implantable pump for four years. Inadequate time between presentation and onset of labour prevented us from using this system. Intravenous patient controlled analgesia with fentanyl using a bolus of 25 μg and a lockout of five minutes was ineffective and epidural analgesia using buprvacaine was initiated and resulted in satisfactory analgesia.

Conclusion

The presence of an existing intrathecal delivery system does not preclude the use of supplemental epidural analgesia during labour.

Keywords

Morphine Bupivacaine Epidural Analgesia Butorphanol Chronic Pain Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Nous décrivons la prise en charge périgestationnelle de l’anesthésie d’une patiente porteuse d’une pompe sous-arachnoïdienne implantée. Il s’agit du premier compte rendu de l’analgésie en cours de travail d’une porteuse de ce dispositif. Comme le système de pompe sous-arachnoïdien est maintenant plus souvent utilisé pour la gestion de la douleur non cancéreuse, il est probable que cette situation se présentera plus fréquemment à l’avenir.

Éléments cliniques

La patiente. une nullipare de 23 ans, avait des antécédents de pancréatite chronique héréditaire et souffrait d’une douleur réfractaire contrôlée depuis quatre années par une pompe implantée. À cause du court délai entre l’admission et le début du travail, il était impossible de faire usage de ce système. L’analgésie intraveineuse contrôlée par la patiente au fentanyl avec un bolus de 25 μg et un intervalle de sécurité de cinq minutes étant inefficace, une analgésie épidurale à la bupivacaïne a été mise en marche et a été satisfaisante.

Conclusion

La présence d’un système sous-arachnoïdien implanté pour l’analgésie n’est pas un obstacle à l’analgésie épidurale complémentaire pendant le travail.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Jordan Tarshis
    • 1
    • 3
  • James E. Zuckerman
    • 2
  • Nathaniel P. Katz
    • 1
  • Scott Segal
    • 1
  • Phillip S. Mushlin
    • 1
  1. 1.Department of AnesthesiaBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Department of Obstetrics and GynecologyBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of AnaesthesiaSunnybrook Health Science CentreTorontoCanada

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