Abstract
This fiveyear retrospective study reviews our experience with epidural obstetric analgesia in patients with previous Harrington rod instrumentation (HRI) for correction of idiopathic scoliosis. Patients were identified by the presence of an antepartum anaesthetic consultation for HRI. The anaesthetic record was examined to determine the frequency of epidural catheter insertion and any problems related to this procedure. Nine epidural insertions were attempted in the 16 patients identified. Five were uncomplicated but four were complicated by one or more of: failure to identify the epidural space, blood vessel trauma, dural puncture, failure to obtain analgesia or the need for multiple attempts before successful insertion. There were no sequelae related to epidural insertion. There were no sequelae related to epidural insertion. We conclude that patients with HRI may be offered epidural anaesthesia for labour and delivery provided that they are informed of the increased risk of complications.
Résumé
Cette étude rétrospective revolt notre experience d’une anal gésie épidurale en obstétrique chez des patientes ayant précédemment subi une opération de Harrington. Neuf insertions de cathéter épiduralfurent tentées chez 16 patientes. Cinq furent sans complication et quatre furent compliquees par une ou plusieurs des complications suivantes: impossibilité d’identifier l’espace épidural, trauma des vaisseaux sanguins, ponction de la dure-mère, impossibilité d’obtenir de l’analgesie ou plusieurs tentatives afin d’insérer le cathéter. On conclut que les patientes ayant HRI peuvent subir une anesthésie épidurale lors du travail et de l’accouchement en autant qu’elles soient informées du risque croissant de complications.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Cochran T, Irstam L, Nachemson A. Long term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine 1983; 8: 576–84.
Kafer ER. Respiratory and cardiovascular function in scoliosis and the principles of anesthetic management. Anesthesiology 1980; 52: 339–51.
Keim HA. Scoliosis. Clin Symp 1979; 31: 2–30.
Harrington PR. Treatment of scoliosis. J Bone Joint Surg 1962; 44A: 591–610.
Wengner DR, Carollo JJ, Wilkerson JA. Biomechanics of scoliotic correction by segmental spinal instrumentation. Spine 1982; 7: 260–4.
The latest wrinkle in correcting scoliosis. Am J Nurs, 1985; 85: 13.
Gazioglu K, Goldstein LA, Femi-Pearse D, Yu PN. Pulmonary function in idiopathic scoliosis. Comparative evaluation before and after orthopaedic correction. J Bone Joint Surg 1968; 50A: 1391–9.
Lindh M, Bjure J. Lung volumes in scoliosis before and after correction by the Harrington instrumentation method. Acta Orthop Scand 1975; 46: 934–48.
Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl MEB. Results of surgical treatment of adults with idiopathic scoliosis. J Bone Joint Surg 1987; 69A: 667–75.
Moskowitz A, Moe JH, Winter RB, Binner H. Long-term followup of scoliosis fusion. J Bone Joint Surg 1980; 62A: 364–76.
Eisenach JC. Orthopaedic disease.In: Obstetric Anaesthesia: The complicated patient. 2nd ed. James FM, Wheeler AS, Dewan DM (Eds.). Philadelphia: F.A. Davis, 1988. 234–6.
Aaro S, Ohlen G. The effect of Harrington instrumentation on the saggital mobility of the spine in scoliosis. Spine 1983; 8: 570–5.
Feldstein G, Ramanathan S. Obstetrical lumbar epidural anesthesia in patients with previous posterior spinal fusion for kyphoscoliosis. Anesth Analg 1985; 64: 83–5.
Schachner SM, Abram SE. Use of two epidural catheters to provide analgesia of unblocked segments in a patient with lumbar disc disease. Anesthesiology 1982; 56: 150–1.
Walpole JB. Continuous lumbar epidural block in labour in the presence of a Meureig Williams plate from L1-L4. Br J Anaesth 1974; 46: 163–4.
Hubbert CH. Epidural anesthesia in patients with spinal fusion. Anesth Analg 1985; 64: 843.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Crosby, E.T., Halpern, S.H. Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can J Anaesth 36, 693–696 (1989). https://doi.org/10.1007/BF03005423
Issue Date:
DOI: https://doi.org/10.1007/BF03005423