L'anesthésie péridurale obstétricale est-elle possible et efficace après chirurgie du rachis ?

Abstract

Objective. – Previous spine surgery theoretically exposes the obstetric patient to a greater technical difficulty during regional analgesia for labour or during anaesthesia for caesarean delivery. Published experience suggests that epidural puncture is however technically possible in the majority of cases. Study design. – Retrospective study. Patients. – Analysis of the files of parturients who gave birth in a maternity hospital during a six year period and who had previously undergone spine surgery. Methods. – Technical failures (during puncture), analgesic failures (complete block inefficiency and/or requirement of a general anaesthetic) and complications (important bleeding at the puncture site, dural tap, infection) observed during epidural analgesia/anaesthesia were recorded. Results. – Except for two paraplegic parturients who had been operated for dorsocervical traumatic injuries and who were excluded from the analysis, 31 parturients had undergone spine surgery and delivered during the period of analysis. Twenty patients underwent 22 epidural punctures. Technical failure were noted in two cases (9%) and analgesic failure in two other cases (9%). No significant complication was recorded. Conclusion. – With an overall 18% failure rate, epidural anaesthesia is not contra-indicated in these patients but appears to be less reliable than in patients with normal spine. Psychological and technical preparation to the occurrence of failure is necessary.