Expert: Ronald Levy, M.D. - 4/11/2011

Question
I have spina bifida occulta at the level of T12 and L1 (no complications in my life ever- wasn't even diagnosed until age 4, no bladder issues, previous x rays show no deformity of the spinal bodies or uneven spacing between the spinal bodies) and am currently 8 months pregnant.  I had an anesthesia consult (no physical exam or imaging studies were conducted) and was told that SBO is an outright contraindication for Epidural/spinal anesthesia and I must have general anesthesia for my scheduled c section. I can find no medical literature that suggests this is the case...  Is this true?  Can they go above the lesion and do the epidural?  I was told epidurals in patients with SBO can result in "patchy" anesthesia and may not provide all over anesthesia for the area that is needed to be covered.  Any insight or additional information would be greatly appreciated!

Thanks so much-
Michelle

Answer
There is not much literature on the subject. I have attached a link to an abstract specifically addressing the issue:

http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=5D4EC06...

That being said, most anesthesiologists will not do an epidural in the face of spina bifeda for several reasons: One is the possibility of a patchy block which would then have to be converted to a general and the second is the potential for litigation should a complication arise. Even if the complication is not a direct result of the epidural, any decent lawyer will make a point that is could be. While I'm not saying that you would be one to seek a lawyer if you had a bad outcome, most anesthesiologists wouldn't even take the chance when there is an alternative. You can try showing the abstract above to your anesthesiologist and see if they would agree.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston