Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

Abstract

SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

Lower Extremity Peripheral Nerve Blocks for Post-operative Pain Control in a Multi-trauma Patient with Brugada Syndrome: A Literature Review and Case Report

“… 8 Of the remaining four cases, two were individual reports of ropivacaine epidurals that provided effective labor analgesia and were uneventful. 15 , 16 The final two individual cases reported the use of epidural bupivacaine, one for labor which was uneventful and the other placed in the thoracic region and combined with GA. 17 , 18 All authors noted the use of low dose or specially concocted infusions in addition to careful titration of local anesthetic, especially when redosing.…”

Labor Analgesia in Brugada Syndrome and the Importance of Contingency Planning

“…Indeed, while bupivacaine has been used intrathecally [18,19], it has been implicated in the induction of a Brugada-type ECG pattern when administered via epidural catheter [20]. Ropivacaine has been used as an epidural infusion in patients with Brugada syndrome [21,22], although one patient developed ventricular tachycardia after bilateral paravertebral blockade with Ropivacaine [23].…”