Continuous spinal analgesia in parturients with severe heart disease

Abstract

Epidural local anesthetic/opioid combinations are routinely used for pain relief during labor and delivery, but the risk of hypotension and reduction in preload may not be tolerated in women with severe heart disease. Spinal opioids produce effective analgesia during the first stage of labor without significant maternal hypotension. 1 Ransom D.M. Leicht C.H. Continuous spinal analgesia with sufentanil for labor and delivery in a parturient with severe pulmonary stenosis. Anesth Analg. 1995; 80: 418-421 PubMed Google Scholar , 2 Okutomi T. Kikuchi S. Amano K. Okamoto H. Hoka S. Continuous spinal analgesia for labor and delivery in a parturient with hypertrophic obstructive cardiomyopathy. Acta Anaesthesiol Scand. 2002; 46: 329-331 Crossref PubMed Scopus (13) Google Scholar Continuous spinal analgesia (CSA) using opioids as the sole agent may provide a safe and stable method of labor analgesia in parturients with severe heart disease. The major disadvantage of CSA, particularly in the obstetric population, is the potential for post-dural puncture headache (PDPH). However, CSA using an over-the-needle catheter reduces the risk of PDPH because there is less cerebrospinal fluid (CSF) leak around a catheter whose outer diameter is larger than that of the spinal needle. [3] Imbelloni L.E. Gouveia M.A. Continuous spinal anesthesia with Spinocath for obstetric analgesia. Int J Obstet Anesth. 2006; 15: 171-172 Abstract Full Text Full Text PDF PubMed Google Scholar It is also superior to the microcatheter-through-the needle technique in terms of ease of insertion, retraction of the needle and catheter threading, spread of anesthetic agent and incidence of catheter obstruction or kinking. [4] Muralidhar V. Kaul H.L. Mallick P. Over-the-needle versus microcatheter-through-needle technique for continuous spinal anesthesia: a preliminary study. Reg Anesth Pain Med. 1999; 24: 417-421 PubMed Google Scholar We tested the efficacy and the reliability of CSA using a Spinocath® catheter (B. Braun Melsungen, Germany) with fentanyl for labor analgesia in women with severe cardiac disease.