Successful Epidural Labor Analgesia In A Patient With Neurofibromatosis Type 1
Medically Challenging Case Report Poster
A 20 yo G2P0 at 37 presented for labor induction for cholestasis. PMH was significant for Neurofibromatosis Type 1 with an extensive cervical plexus infiltrating lesion, asymmetric quadriparesis and C2-C4 fusion with kyphoscoliosis and limited neck mobility. She was taking enoxaparin for Factor V Leiden, but had no administration for >24 hours. MRI showed no lumbar neurofibromas. After assessing risks and benefits of neuraxial anesthesia in the setting of potentially difficult airway and existing neurologic deficits, she elected to receive epidural analgesia. A lumbar epidural was placed with administration of bupivacaine & fentanyl and PIEB boluses with PCEA available. She had NSVD and subsequent uncomplicated postoperative course.
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