Epidural Analgesia in a Parturient for Labor Analgesia After Surgical Correction of Spina Bifida

This case report details the successful management of labor pain using epidural analgesia in a 22-year-old primigravid patient with a history of spina bifida and extensive surgical repair. Spina bifida, a congenital neural tube defect, presents unique challenges for neuraxial anesthesia due to altered spinal anatomy and potential neurological deficits. Despite these complexities, effective pain relief was achieved through careful patient counseling, comprehensive pre-procedural planning, and meticulous technique. Upon admission for labor induction due to preeclampsia, a physical examination revealed significant lumbar scarring with obscure anatomical landmarks. Despite these challenges, informed consent was obtained, and an epidural catheter was successfully placed using palpable bony prominences above the presumed T12-L1 interspace. A standard midline approach with saline loss of resistance technique was employed, epidural space was confirmed at a depth of 5 cm, and a catheter was placed. Continuous patient-controlled epidural analgesia (PCEA) comprising fentanyl and ropivacaine provided consistent pain relief throughout a 17-hour labor period, maintaining a dermatome level of T10. Post-delivery, neurosurgical evaluation confirmed successful catheter removal without complications, and the patient exhibited normal neurological function. This case underscores the importance of individualized pain management strategies in patients with spina bifida, necessitating thorough risk-benefit assessment, detailed patient education, and interdisciplinary collaboration for optimal outcomes. Despite the inherent challenges, epidural analgesia can be a viable option with careful planning and execution, contributing to improved maternal comfort and satisfaction during labor and delivery for patients with a history of spina bifida.