Labour pain management in a parturient with an implanted intrathecal pump

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
J TarshisP S Mushlin

Abstract

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. 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 micrograms and a lockout of five minutes was ineffective and epidural analgesia using bupivacaine was initiated and resulted in satisfactory analgesia. The presence of an existing intrathecal delivery system does not preclude the use of supplemental epidural analgesia during labour.

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Citations

Jun 7, 2003·The Clinical Journal of Pain·Martha J WunschSidney H Schnoll
Feb 20, 2007·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Louise M ByrdTracey Johnston
Jul 20, 2012·Revista española de anestesiología y reanimación·E Domínguez SuárezM L Rodríguez Vázquez
Aug 16, 2011·International Journal of Obstetric Anesthesia·M BadveM C Vallejo
Nov 28, 2009·PM & R : the Journal of Injury, Function, and Rehabilitation·Christina M MortonKristi L Kirschner
Nov 22, 2008·International Journal of Obstetric Anesthesia·W Ali Sakr EsaS Barsoum
Jan 26, 2006·International Journal of Obstetric Anesthesia·J L Hanson, E J Goodman
Mar 22, 2015·International Journal of Obstetric Anesthesia·J A AnsonP M McQuillan
Feb 10, 1999·Anesthesiology·J M BédardR N Wissler
Apr 23, 2015·Regional Anesthesia and Pain Medicine·Adam C YoungAsokumar Buvanendran
May 10, 2007·Acta Anaesthesiologica Scandinavica·M Vercauteren, L Heytens
Sep 23, 2008·Anesthesia and Analgesia·Jay S GriderGeorge W Colclough

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