Chronic pain affects approximately 100 million Americans with an incidence of 3 million cases per year and almost half of these cases include middle-aged females. In certain refractory cases chronic pain management may include the placement of a spinal cord stimulator. Considering half of chronic pain cases involve middle-age women, which also encompasses the reproductive years, obstetric anesthesiologists has encountered a new challenge: caring for the pregnant patient with an implanted spinal cord stimulator. This new encounter may become more commonplace as women are now delaying childbirth into their thirties and almost one fifth of these women are over the age of 35. There is limited data on the safe administration of neuraxial anesthesia to a pregnant patient with an implanted spinal cord stimulator, particularly a thoraco-lumbar stimulator. This case report documents a pregnant patient with an implanted thoraco-lumbar spinal cord stimulator who successfully received neuraxial analgesia intrapartum during two separate pregnancies. The patient is a 36-year-old female who suffers from refractory chronic back pain and received a thoraco-lumbar spinal cord stimulator after spinal fusion failed to relieve her pain. During her first pregnancy the stimulator was inactivated due to its unknown potential risks to the developing fetus. Intrapartum the obstetric anesthesiologist successfully administered neuraxial anesthesia under ultrasound guidance thus providing analgesia during labor and delivery. In 2017 she presented to labor and delivery as a gravida two with the inactive spinal cord stimulator and successfully received neuraxial anesthesia under ultrasound guidance a second time.
Kett A, Gentile ND and Kocur M