Expert: Ronald Levy, M.D. - 11/29/2010

Question
I am 30 weeks pregnant with my 5th child. History of very
fast labors (2-4 hours. Allergy to general anesthesia
Malignant Hyperthermia.  

In my 1st week of this pregnancy I fell and had increasing
lumbar/sacral back pain leading to severe right sided
sciatica, pelvic instability, loss of mobility, use
wheelchair and walker to ambulate.

MRI at 26 wks gestation diagnosed significant L5 rupture and
a smaller S1 herniation. Treatment has been dexamethasone
patch, physical therapy, hydrotherapy, some pain
medications. I can achieve pain free positions side lying
and sitting.

I was wondering if my ruptured disc's could interfere with a
spinal-epidural during my labor.
1. Am I a candidate for a spinal-epidural or some other
anesthesia.
2. Are there increased risks associated with the epidural
i.e nerve not moving out of the way in the epidural space
due to occlusion or injury.
3. Is there a record of not being able to achieve analgesia
due to disc herniations at L5/S1?
4. Would I be able to labor on my side or on all fours with
spinal-epidural?

Thank you so much for your response. I've been searching
everywhere for information on this.  

Answer
Here are the answers to your questions:

I was wondering if my ruptured disc's could interfere with a
spinal-epidural during my labor?

    Yes it could. Often people with disc issues get patchy blocks so it might work, it miht partially work. Spinal would be a better option if you're having a c-section. More importantly, many anesthesiologists wouldn't even try a block if you are having sciatic symptoms because if it got worse, they would have no defense that the epidural didn't cause it (even if it didn't)

1. Am I a candidate for a spinal-epidural or some other
anesthesia.

    You may be. It is up to the anesthesiologist if they feel comfortable doing it


2. Are there increased risks associated with the epidural
i.e nerve not moving out of the way in the epidural space
due to occlusion or injury.

    Generally not but when people do have post op numbness, etc (usually due to other factors) they often blame the epidural.


3. Is there a record of not being able to achieve analgesia
due to disc herniations at L5/S1?

    As I mentioned above, people often have patchy blocks but it is rare that they get no effect at all.


4. Would I be able to labor on my side or on all fours with
spinal-epidural?

    No because then the block would only work on that side. As for all fours, you would not be able to maintain your weight like that.

The key for you is to speak to the anesthesiologist in advance so you can develop an analgesic plan.


Hope this helps,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston