Pregnancy Epidural After Lumbar Surgery?

[xinerevelle]

I had a partial discectomy and laminotomy at L4-L5 and L5-S1 in late Deceraber, 2005. I am now 31 weeks pregnant, and aside from the SI joint pain that was discovered after I had the surgery (and which has flared up in pregnancy) I've done pretty good since the surgery.

Due to my "extended butt crack" scar, I met with an anesthesiologist yesterday for a "pre-op" type of visit so that when I do go into labor no one is trying to figure out at the last minute how to get me an epidural for pain relief. The anseth. doc said that it depenRAB on which doctor is doing the epidural, since some put it higher than others (he said he usually does it in the L2/L3 area). He also warned of a spinal headache (which I already had with the myelogram I had the month before my surgery). He then said that a blood patch to fix the spinal headache would be as difficult to administer as an epidural. sigh.

Then he said it might not even work due to scarring and the "tampering" (his word) of the parts in there -- that the medication may not reach the parts due a restricted flow. sigh.

Then he said that it would be easiest for the anesth folks if I had a c-section. That way they could do a spinal (which is easier for them to "feel" as they insert the needle, especially if there is tissue scarring to obscure the resistance).

So now I'm in a quandry... do I even consider a c-section solely for the purposes of pain management? (I may end up with one anyway due to some other issues... but that has not been determined yet). Is having a baby vaginally going to do damage to my already aching SI joints? I'm not a fan of c-sections just for convenience (schedule, trying to get out of labor, etc.). I was not given a percentage probabilty that the epi would work or not. Guess there's not that much research there.

(Please, no comments about natural childbirth... I already know that I want pain meRAB after all the pain I've been in for the past few years with my back (workers comp, nonetheless) and I don't want to tough it out after 9+ months without any pain meRAB during pregnancy.)

 

[c9309]

I have had a discectomy and laminotomy at L3-4 and L4-5 two years apart - while my husband and I don't have children yet (we're newlyweRAB) we have been considering it - and an epidural has been one of the issues.

Prior to my second back surgery and at the direction of my Ortho surgeon, we met with a high risk OB and Anesthesiologist to get our questions answered. First, I would suggest meeting with a high risk OB, even if you are already far along in your pregnany. He brought up quite a few good points as to how to handle weight gain and back pain, as well as other things. He also said that it is possible that the prior back problems and the way the nerves wrap from the spine to the abdomen could cause major complications, and that it would be good to be monitered and have someone that knows my case that has dealt with this in the past if this were to arise.

As for the Anesthesiologist, he suggested a live feed. Basically, it is a "living x-ray" which allows the person doing the epidural to see the needle as they push it through the spine. He did say that there was a higher risk of paralyzation from the epidural due to the scar tissue, and that can last from days after the initial procedure to being permanent. He did say that the live feed would be our best bet.

As for the SI joint pain, we also met with a pain specialist because I also have alot of SI pain, and they suggested getting the joints injected either prior to the pregnancy or early into the pregnancy. Bed rest after the 6 month mark has been deemed neccessary by more than one doctor as well.

I hope this helps - I have alot of confidence in the Anesthesiolgist that we saw because we did alot of "shopping around" prior to taking his advice to heart.

As for our chance of getting pregnant, my husband and parents were told by my surgeon after my second back surgery (while I was in recovery) that we shouldn't have children because he was afraid my spine would go out of place and not go back in, and that I had a huge chance of permanent paralyzation. Have you heard of this? Any info or your experiences would be great. Thanks!