The management of nonobstetric pains in pregnancy

Abstract

Objective: Nonobstetric pain in pregnancy is usually managed with simple analgesia and reassurance that the condition will be self-limiting. However, sometimes such pain can be severe enough to warrant a different approach. We present 3 cases of uncontrolled pain in pregnancy, which were treated with nerve block techniques. Case Report: The first patient had a recurrence of pain similar to that experienced during her first pregnancy related to stretching of her lower ribs; this was relieved completely by injection of bupivacaine 0.5% and triamcinolone. Another patient had symphyseal pain, which had required induction of labor during her previous pregnancy due to its severity. She had only brief relief on injection. The third patient experienced severe pain related to a Pfannenstiel incision scar from a previous cesarean delivery, which was completely relieved by injection. A review is presented of nonobstetric pains and their treatment options that may occur in pregnancy, including neurogenic, musculoskeletal, neuropathic, and referred pains. Conclusion: We conclude that a single bolus injection of local anesthetic and steroid, when performed carefully by a pain management specialist, is a safe and potentially effective alternative to conventional analgesic treatment of somatic pain associated with the uterine enlargement of pregnancy. Reg Anesth Pain Med 2003;28:54-57.