A 32-year-old primigravida woman received an epidural anesthetic at 38 weeks of gestation for an elective caesarean delivery. She had for the past 10 years an intrathecal baclofen infusion pump to relieve spastic tetraparesis secondary to perinatal cerebral anoxia. She otherwise also suffered from sickle cell disease complicated by several vaso-occlusive crisis during pregnancy and a recent history of thromboembolic disease. A recent CT scan showed the intrathecal catheter entering the L3-L4 interspace and extending proximally to the thoracic region. For the caesarean delivery, an epidural catheter was sited using ultrasound in the L4-L5 interspace. Motor block and analgesia was obtained with a tested sensitive level never rising above T9. The patient was informed of the clinical situation and eventual risk of converting to general anesthesia if too uncomfortable during the caesarean section. Despite this she wished to forgo a general anesthesia if possible. It was decided to proceed with the caesarean delivery under epidural anesthesia. The caesarean section was uneventful, and no complications occurred in the post-natal period.
Neuraxial anesthesia may be favored over general anesthesia for patients with sickle cell disease, but epidural local anesthetic spread may be unpredictable following interventions involving the epidural space as illustrated by this case report.