Neuraxial Analgesia in a Parturient with Thoracolumbar Spinal Fusion and Other Comorbidities: An Interdisciplinary Peripartum Management Approach

We present the case of a 31-year-old term parturient with a history of extensive thoracolumbar spinal fusion and a repaired anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), who requested epidural analgesia for vaginal delivery. Given her cardiac history, preprocedural intravenous fluid administration was intentionally avoided to minimize the risk of volume overload and hemodynamic compromise. Despite a midline surgical scar extending to L4, posterior spinal instrumentation from T2 to L2, and mild residual spinal curvature, all of which distorted surface landmarks and posed technical challenges to neuraxial access, the patient’s anatomy was carefully evaluated. A lumbar epidural catheter was successfully placed at the L4 - L5 interspace using a median approach. A test dose confirmed correct placement without intravascular or intrathecal migration, and the initial bolus of local anesthetic was deferred to minimize the risk of abrupt sympathetic blockade. This case demonstrates the feasibility and safety of neuraxial labor analgesia in patients with coexisting spinal deformity and congenital cardiac disease, and underscores the importance of individualized anesthetic planning, meticulous technique, and multidisciplinary collaboration.