Epidural anaesthesia and neural tube defects

Regional Anesthesia in Patients With Preexisting Neurologic Disease

“…The authors cautioned that performing neuraxial techniques within this patient population can be technically challenging, with an increased risk of inadvertent dural puncture and unpredictable local anesthetic spread. 120 If neuraxial anesthesia or analgesia is performed under these clinical circumstances, it is recommended that the site of needle insertion occurs at a level above the original lesion because of limitations in local anesthetic spread. 116 Spina bifida occulta is a common closed spinal dysraphism that is thought to be a normal variant of vertebral column development.…”

“…The use of regional anesthesia in parturients with isolated spina bifida occulta has been reported but is limited to anecdotal case reports 121 and small case series. 120,122 Within this collection of 11 reported cases, successful epidural analgesia was achieved with normal doses of local anesthetic without extensive cranial spread of local anesthetic, sacral sparing, or adverse neurologic sequelae. One patient experienced technical difficulties during block placement, including the elicitation of a transient paresthesia and inadvertent dural puncture.…”

Lumbar Spine Anatomy in Women Sustaining Unintentional Dural Puncture During Labor Epidural Placement

“…An attempt to perform an epidural catheter placement at the level where an SBO is present carries a high risk of unintentional dural puncture. 11 It remains to be determined whether a preprocedure ultrasound assessment will be able to detect the presence of SBO in adult subjects. More recent work on the anatomy of the human lumbar spine by Reina et al 12 further illustrates the complex structure of the ligamentum flavum.…”

UK registry of high-risk obstetric anaesthesia: report on neurological disease

“…This probably reflects the incidence of these neurological conditions in the childbearing age group. 3,4 Eight of the 23 patients with spina bifida had regional analgesia or anaesthesia, in all cases epidurals. It may be that anaesthetists were mindful of the fact that some patients may have a low and tethered cord, and feared cord damage with spinal anaesthesia.…”