Labor analgesia for the parturient with prior spinal surgery: what does an obstetrician need to know?

Administration of lumbar epidural analgesia in a parturient with previous spinal surgery presents a unique challenge to the anesthesiologist. These challenges (difficulties) range from inability to identify the epidural space, multiple attempts before catheter insertion, vascular trauma, and/or subdural local anesthetic injection to accidental dural puncture. The literature documenting management of labor analgesia in pregnant women with prior spinal surgery is limited to a handful of case reports. This author is not aware of any other review articles in English literature discussing special considerations for labor analgesia in parturients presenting with history of prior spinal instrumentation.