Scoliosis and epidural.

[Celine31]

Hi!I have mild scoliosis since i was a child.Is it possible to get an epidural during a labour?my midwive did not give me straight answer so still not sure and going to be induced next week so may need strong painkiller.

Looked on the database at work for you - don't know if this means much but this is what it says:

"Scoliosis can pose challenges to the initiation and function of neuraxial anesthetics. We reviewed the available literature exploring neuraxial techniques in parturients with uncorrected or corrected (i.e., surgically instrumented) scoliosis. The 22 articles reported 117 attempted neuraxial procedures (uncorrected n = 24 and corrected n = 93). Of these procedures, 79% of uncorrected patients and 69% of corrected patients were successfully managed with neuraxial anesthesia. Procedures were typically more challenging in corrected patients; 90% of all reported difficulties in this subgroup involved epidural anesthetics. Complications were reported in 3 of 103 patients. We provide suggestions for optimizing efficacy of neuraxial techniques in these patients."

I have this mildly too and I did have an epidural - it really depends on your anesthetist and your spine. It was a bit of a challenge and I know in my case she had (I think) to do a spinal too but it worked. I was warned it might only work on one side but it did actually fully work although they had to top me up more than usual. I think the doc quite enjoyed the challenge of doing it!.

If you can I would ask to see a senior anesthetist before they induce you and make sure they are aware of the scoliosis (I did this) so they are prepared for it and if necessary someone more senior can do it if necessary. Make sure it is in your notes too.

The only other top I would give you is don't leave it too long in requesting an epidural if you think you are heading towards needing one. I kept thinking I could go without and then when I finally couldn't anymore (and had worked my way through all the other drugs) I had to wait for too long (and was in a great deal of pain that I couldn't manage). It wasn't painful having it done either... the worst bit was having the plaster ripped off the next day!

It was bliss when I had it, my whole body relaxed and everything went as well as it could after that.

Celine - another comment from someone in work. (This is the gist - this converstion has gone on since my last post! If there are any obstetric anaesthetists (OA) out there I humbly apaologise if I have got anything wrong.) They said it is very difficult for obstetric anaesthetists to site the epidural if the woman is climbing the wall in pain and can't keep still - the OA won't want to be faced with someone with scoliosis in this situation. So it is important to ask for the epidural early. Apparently some midwives don't understand this and it makes OAs very cross!!!

The other thing is that (although hopefully it is not likely) if some problems developed during labour, OAs like to know about your problem in advance. NHS communication being what it is, they don't want to rush in to do the epidural/spinal in an emergency, discover you've got a problem and then find they can't do it fast enough or well enough and have to switch to a general anaesthetic - it is all wasted minutes. If they know in advance they can hopefully have an experienced rather than junior OA to do it.

So the suggestion was to talk to the midwife and get a referral to see the Obs Anaesthetist in advance - my colleague reckons most OAs run this service for women who have potential anaesthetic problems. They can have a look at your spine and may say hey ho no problem but if necessary they will have a plan of action as to what to do if you need special care. Good luck and I better do some work now or I shall get sacked! :)

Sorry, Lucy - you've said much the same as me, our posts crossed.

Hi - I was the same i.e. mild scoliosis. I had a consultation with the anaesthetist at about 30 weeks and she confirmed that the curvature was mild enough to not cause any problems.

On the day, my first anaesthestist struggled but then the consultant took over and he managed it first time without any fuss. So, I think it is a bit of a matter of luck to be honest that you have a skilled doctor in call - but my understanding is that medically it shouldn't be too difficult to do

You should've seen an anaesthetist to discuss this already afaik and so they can check out your back before you're in labour. I have hyperlordosis (excessive front-back curvature) and had an appointment at about 24 weeks. Anaesthetist said I should be fine.

I'd push to see an anaesthetist before the labour.

Not sure if this is helpful information or not, but I have a 32 degree curvature in my spine with rotation. I also had a spinal fitted in a (very emergency) EMCS. It was completely effective and I don't think the anaesthetist struggled at all with fitting it. Now, I don't know how epidurals and spinals differ in placement (if at all) but that was my experience.

However, you have reminded me I must get that in my notes this time. Am nearly 39 weeks now and haven't noted it and will try for VBAC, so better get that clear for consultant and MW!

I also have a scoliosis and an old spinal fracture, in fact the fracture is in exactly the place where the epidural needle would usually be inserted. I was advised to bring my xrays to show the anaesthetist (this couldn't be done in advance as they don't know which anaestetist will be on duty) if i should need an epidural.

i did need an epidural and after looking at the xray the anaestetist decided to put the needle in 2 vertabrae higher than usual - all fine and paineless.