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Reg Anesth Pain Med · Nov 2016
Case ReportsLabor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal.
- David M Dickerson, Ran Dai, Barbara M Scavone, and William McDade.
- From the *Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL; and †Ochsner Health System, New Orleans, LA.
- Reg Anesth Pain Med. 2016 Nov 1; 41 (6): 776-779.
AbstractReports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.
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