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      Spinal anesthesia for cesarean section in a woman with an intrathecal baclofen pump

      case-report

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          Abstract

          Background

          Intrathecal baclofen pumps are commonly used for the management of lower extremity spasticity in the setting of spinal cord injury. There have been no reports of the performance of spinal anesthesia in patients with a pre-existing intrathecal baclofen pump.

          Case presentation

          A 29-year-old parturient presented for cesarean section. She had a history of spinal cord injury due to fractures of the thoracic vertebrae with lower extremity spasticity, which had been treated with an intrathecal baclofen pump inserted through lumbar (L) 3-L4 intervertebral space. Preoperative lumbosacral ultrasound was performed to identify the L4-5 interspace, and spinal anesthesia was performed through that space with a 25-gauge 3.5-inch-long Whitacre spinal needle. Thoracic (T) 4 dermatomal level anesthesia was achieved, and the patient underwent the cesarean section without requiring additional intravenous analgesic adjuncts.

          Conclusions

          Spinal anesthesia can be successfully performed in patients with intrathecal baclofen pumps. Existing intrathecal catheters can be located with preoperative imaging, and ultrasound can be used to determine the vertebral levels below the intrathecal catheter through which spinal anesthesia can be performed safely.

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          Most cited references4

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          The parturient with implanted spinal cord stimulator: management and review of the literature.

          Spinal cord stimulation (SCS) is an approved treatment for complex regional pain syndrome and other chronic pain conditions. These devices enable women with chronic pain to maintain relatively normal lives, with some encountering pregnancy. Use of previously implanted SCS systems in pregnant women is considered controversial due to lack of long-term prospective studies evaluating both maternal and fetal safety. Seven patients at a university pain clinic were identified as having SCS implanted before becoming pregnant. Data on these patients before, during, and after labor were collected through chart review and patient interview. Onset of labor varied among the 7 patients (2 preterm and 5 term). Mode of anesthesia for delivery included 4 neuraxial anesthetics, with 3 successfully obtaining an adequate level of anesthesia for delivery. Four general anesthetics were administered for cesarean delivery, one of which included a failed attempt at neuraxial anesthesia. All infants were born healthy. Management approaches and outcomes in our patients, as well as those previously reported are discussed within this article. Definitive conclusions cannot be drawn from this small cohort. We believe that management of a parturient with an implanted SCS requires careful planning between all peripartum physicians.
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            Epidural analgesia in labor for a woman with an intrathecal baclofen pump

            A 28-year-old woman in active labor at 38 weeks of gestation requested epidural analgesia. She had previously received an intrathecal baclofen infusion pump to relieve the spasticity of cerebral palsy. She had right hemiparesis and cerebral palsy but was otherwise healthy. The patient had been seen one month before her expected delivery date by a staff anesthesiologist. A lumbar X-ray demonstrated the intrathecal catheter entering the L3-4 interspace and extending to the mid-thoracic region. For labor analgesia the epidural space was identified at L4-5 with the patient sitting, using a standard 17-gauge Tuohy needle. An epidural catheter was threaded to 5 cm and provided effective analgesia until delivery four hours later. There were no postnatal complications.
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              Labour pain management in a parturient with an implanted intrathecal pump.

              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.
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                Author and article information

                Contributors
                allen.heath@gmail.com
                ryukomatsu80@gmail.com
                elomrani@uw.edu
                Journal
                JA Clin Rep
                JA Clin Rep
                JA Clinical Reports
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2363-9024
                22 March 2022
                22 March 2022
                December 2022
                : 8
                : 23
                Affiliations
                [1 ]Denali Anesthesia, Alaska Regional Hospital, 2801 Debarr Road, Anchorage, AK 99508 USA
                [2 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Anesthesiology and Pain Medicine, , University of Washington, ; Box 356540, 1959 NE Pacific Street, BB-1469, Seattle, WA 98195-6540 USA
                Author information
                http://orcid.org/0000-0002-3743-3649
                Article
                515
                10.1186/s40981-022-00515-6
                8941058
                35316422
                fff7cbb9-a1e8-4aff-8ddf-8045020fac25
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 15 January 2022
                : 10 March 2022
                : 12 March 2022
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2022

                intrathecal pump,baclofen,neuraxial anesthesia,cesarean section

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