Expert: Ronald Levy, M.D. - 9/9/2008

Question
Hello Dr. Levy,
I am expecting our second child in January of this year. Our first was born in
January of 2005 via cesarian after a change within our daughters heart rate. I
was given a epidural about 12 hours prior to the surgery and informed the
CRNA several times I still maintained feeling on my right side. During the
procedure I almost immediately felt searing burning pain on my right side
that only increased as the surgery progressed. The CRNA gave me several
boluses of fentanyl and other IVP drugs during the progression of the
surgery. However all that resulted was a episode of projectile vomiting that
covered the drape. My husband and I were both terrified and were robbed of
our joyful birth experience.  Prior to the epidural I told the CRNA I had a
history of a ruptured disk as well as nerve problems, specifically on the right
side. He assured me it would have no impact on the delivery of pain
medication.  While in recovery the pain subsided completely and I fell sleep to
such a degree I wolke up with a non rebreather on and my daughter in my
arms. The epidural controlled my postoperative pain very efficiently in fact I
requested to have it removed early and did fine without in post-op day two.
Understandably my husband and I are again afraid this may happen with our
second child. My OB has advised me to proceed with a scheduled C section
due to the hemorrhaging I experienced in recovery as well as the problems I
had with labor progression of our first child. We are both comfortable with
the idea of unconscious sedation , however I would hate to take the birth of
our son away from my husband. Can you please tell me what you think may
have gone wrong the first time as well as any other options we may have for
pain control that will allow for my husband to be present for the birth of his
only son.
Thank you
Amy

Answer
It is not uncommon (especially for people with disk problems) to have a patchy block with the epidural. Often we can cover the "hot spot" with more medication but sometimes it doesn't work. As for you next child, since it is a scheduled section, they will likely do a spinal anesthetic this time. These blocks are denser, have a much higher success rate, and are easier to place so that you will not have to be sedated and both you and your husband will be able to enjoy the birth experience without pain.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston