So I just finished doing a combined-spinal/epidural on a woman who has had scoliosis of her back repaired. The usual risks of neuraxial analgesia--inadvertant dural puncture, headache, difficulty placing the catheter--are all greatly increased in patients with a history of back surgery.
This patient was in the hospital last week for induction of labor, but when the obstetrical anesthesia fellow wasn't able to place the epidural, the patient was sent home.
She came in tonight in spontaneous labor, and again requested an epidural. This time I was on duty. And can I say that--*boom*--one one attempt, the spinal was given and the epidural catheter threaded easily!
On this note of success, it's now time to hand off the primary pager to Todd, my co-resident who's been sleeping peacefully for the last few hours, and it's my turn to hit the sack.
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Todd was called an hour or so later that the patient was again in pain. Evidently the catheter threaded downward rather than upward, because she had a nice band of anesthesia...from her knees down! He gave her another spinal which carried her through delivery.
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