Epidural analgesia in labor for a woman with an intrathecal baclofen pump.

A 28-year-old woman in active labor at 38 weeks of gestation requested epidural analgesia. She had previously received an intrathecal baclofen infusion pump to relieve the spasticity of cerebral palsy. She had right hemiparesis and cerebral palsy but was otherwise healthy. The patient had been seen one month before her expected delivery date by a staff anesthesiologist. A lumbar X-ray demonstrated the intrathecal catheter entering the L3-4 interspace and extending to the mid-thoracic region. For labor analgesia the epidural space was identified at L4-5 with the patient sitting, using a standard 17-gauge Tuohy needle. An epidural catheter was threaded to 5 cm and provided effective analgesia until delivery four hours later. There were no postnatal complications.