Epidural analgesia in labour for a patient with hereditary neuropathy with liability to pressure palsy

Abstract

Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare but probably under-diagnosed disorder of peripheral nerves in which individuals suffer from repeated motor and sensory neuropathies (pressure palsies) following brief nerve compression or mild trauma. A seemingly trivial insult such as sitting or kneeling may result in a focal neurological deficit lasting for hours to months. Despite the growing recognition of this problem, information regarding the anaesthetic management of labour is sparse. We present a woman with HNPP who was provided with a modified epidural regimen (low concentration bupivacaine and fentanyl) for analgesia in labour and delivery. Labour progressed uneventfully and there were no neurological sequelae following delivery.