Obstetric epidural anaesthesia in patients with Harrington instrumentation

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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. 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.