Successful Labour Analgesia in a Patient with Posterior Corrective Surgery for Thoracolumbar scoliosis -A Case Report

ABSTRACT: Background: Administration of lumbar epidural analgesia in a parturient with previous spinal surgery presents a particular challenge to the anaesthesiologist. The difficulties could range from inability to identify the epidural space, multiple attempts before catheter placement, vascular trauma, subdural local anaesthetic injection and accidental dural puncture. Methods: We report successful labour analgesia in a parturient with congenital scoliosis corrected with extensive posterior instrumentation. Combined spinal- epidural analgesia was performed through L4-L5 interspace, although it was done under ultrasound guidance it was technically difficult as two attempts were required for spinal puncture. Results: The patient had a normal vaginal delivery with satisfactory sensory analgesia. There was no post-procedure complication encountered. Conclusion: Lumbar epidural analgesia is known to be technically difficult in patients with prior spinal surgery. We recommend early assessment by a multidisciplinary team of experts, including obstetricians, obstetric anaesthesiologists, and spine surgeons to develop an individually tailored peripartum care plan for labour analgesia.