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.
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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References
Perrault J. Hereditary pancreatitis.In: Haubrich WS, Schaffner F, Berk JE (Eds.). Gastroenterology, 5th ed. Philadelphia: WB Saunders, 1995; 2969–74.
Onofrio BM, Yaksh TL. Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg 1990; 72: 200–9.
Andersen PE, Cohen JI, Everts EC, Bedder MD, Burchiel KJ. Intrathecal narcotics for relief of pain from head and neck cancer. Arch Otolaryngol Head Neck Surg 1991; 117: 1277–80.
Arnér S, Rawal N, Gustafsson LL. Clinical experience of long-term treatment with epidural and intrathecal opioids — a nationwide survey. Acta Anaesthesiol Scand 1988; 32: 253–9.
Chambers FA, MacSullivan R. Intrathacal morphine in the treatment of chronic intractable pain. Ir J Med Sci 1994; 163: 318–21.
Hassenbusch SJ, Stanton-Hicks M, Covington EC, Walsh JG, Guthrey DS. Long-term intraspinal infusions of opioids in the treatment of neuropathic pain. J Pain Symptom Manage 1995; 10: 527–43.
Tutak U, Doleys DM. Intrathecal infusion systems for treatment of chronic low back and leg pain of noncancer origin. South Med J 1996; 89: 295–300.
Prager JP, DeSalles A, Wilkinson A, Jacobs M, Csete M. Loin pain hematuria syndrome: pain relief with intrathecal morphine. Am J Kidney Dis 1995; 25: 629–31.
Kanoff RB. Intraspinal delivery of opiates by an implantable, programmable pump in patients with chronic, intractable pain of nonmalignant origin. J Am Osteopath Assoc 1994; 94: 487–93.
Waldman SD, Coombs DW. Selection of implantable narcotic delivery systems. Anesth Analg 1989; 68: 377–84.
Krames ES. Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manage 1993; 8: 36–46.
Rayburn W, Rathke A, Leuschen MP, Chleborad J, Wiedner W. Fentanyl citrate analgesia during labor. Am J Obstet Gynecol 1989; 161: 202–6.
Daley MD, Rolbin SH, Hew EM, Morningstar BA, Stewart JA. Epidural anesthesia for obstetrics after spinal surgery. Reg Anesth 1990; 15: 280–4.
Kwan JW. Use of infusion devices for epidural or intrathecal administration of spinal opioids. Am J Hosp Pharm 1990; 47(Suppl 1): S18–23.
Wu CL, Patt RB. Accidental overdose of systemic morphine during intended refill of intrathecal infusion device. Anesth Analg 1992; 75: 130–2.
Byers K, Axelrod P, Michael S, Rosen S. Infections complicating tunneled intraspinal catheter systems used to treat chronic pain. Clin Infect Dis 1995; 21: 403–8.
Bennett MI, Tai YMA, Symonds JM. Staphylococcal meningitis following Synchromed intrathecal pump implant: a case report. Pain 1994; 56: 243–4.
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Tarshis, J., Zuckerman, J.E., Katz, N.P. et al. Labour pain management in a parturient with an implanted intrathecal pump. Can J Anaesth 44, 1278–1281 (1997). https://doi.org/10.1007/BF03012776
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DOI: https://doi.org/10.1007/BF03012776