[Obstetric analgesia for a patient with a history of 3 previous operations on the spine]. / Analgesia obstétrica en una paciente con tres cirugías previas de columna.

A history of spinal surgery is not currently considered a contraindication for regional obstetric analgesia. However, there are highly complex cases in which choosing the best analgesic technique presents genuine problems. We report the case of a woman in labor at full-term with 4-cm dilatation of the cervix who had undergone 3 operations for scoliosis and a herniated disk treated by T5-L4 and L4-sacral arthrodesis, laminectomy, and diskectomy. No previous anesthetic plan was in place, so we chose intravenous patient-controlled analgesia for labor and vaginal delivery and spinal anesthesia for a cesarean delivery. However, general anesthesia became necessary because it was impossible to reach the dura mater. The literature was reviewed to assess alternative forms of obstetric analgesia for patients who have undergone scoliosis surgery.

Analgesia obstétrica en una paciente con tres cirugías previas de columna / Obstetric analgesia for a patient with a history of 3 previous operations on the spine

En la actualidad se considera que la cirugía previa dela columna no es una contraindicación para la analgesiaobstétrica locorregional. No obstante, existen casos degran complejidad en los que la elección de la mejor técnicaanalgésica es un auténtico problema. Presentamosel caso de una gestante a término con trabajo de parto y4 centímetros de dilatación con el antecedente de 3 intervencionessobre columna, por escoliosis y hernia discal,a la que se había realizado artrodesis T5-L4, L4-sacro,laminectomía y discectomía. Sin un plan anestésico previo,optamos por PCA intravenosa para el trabajo departo y anestesia intradural para la cesárea, pero porimposibilidad técnica para alcanzar la duramadre fuenecesario recurrir a la anestesia general. La revisión dela bibliografía permite valorar las alternativas para laanalgesia obstétrica en pacientes sometidas a cirugíaprevia de la escoliosis

A history of spinal surgery is not currently considereda contraindication for regional obstetric analgesia.However, there are highly complex cases in which choosingthe best analgesic technique presents genuine problems.We report the case of a woman in labor atfull-term with 4-cm dilatation of the cervix who hadundergone 3 operations for scoliosis and a herniateddisk treated by T5-L4 and L4-sacral arthrodesis, laminectomy,and diskectomy. No previous anesthetic planwas in place, so we chose intravenous patient-controlledanalgesia for labor and vaginal delivery and spinalanesthesia for a cesarean delivery. However, generalanesthesia became necessary because it was impossibleto reach the dura mater. The literature was reviewed toassess alternative forms of obstetric analgesia forpatients who have undergone scoliosis surgery