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Obstetric Anaesthesia Annual Scientific Meeting 2025
May 15 - 16, 2025 | ICC, 2 Lanyon Place, Belfast BT1 3WH
6779627
Epidural labour analgesia in a patient with sacral nerve stimulator
Poster Presenter
Authors
Affiliations
Part of Topic
Case report
Introduction:
• Sacral nerve modulation is used for the management of bladder and bowel dysfunction.
• It is particularly advantageous in patients who have failed conservative management.
• Sacral nerve stimulator (SNS) is a device consisting of an external stimulator with leads placed adjacent to the sacral nerves. It modulates sacral nerves and provides symptomatic relief by restoring bladder or bowel function.
• When inserted for the management of non-obstructive urinary retention, it reduces the incidence of recurrent urinary tract infections and chronic kidney disease.
• Theoretical concerns: reduction in fertility, teratogenicity, and device damage during vaginal delivery1.
Case report:
• 29-Year-old, primigravida, requested for a labour epidural at 4 cms dilatation.
• Past medical history: interstitial cystitis, recurrent urinary tract infections (UTIs), asthma, ovarian cyst.
• Urethral dilatation in 2016.
• SNS in situ, for myogenic bladder, since 2017.
• Significant reduction in UTIs after sacral neuromodulation.
• SNS turned off by the primary team at 10/40, leading her to self-catheterise two to three times per day.
• Imaging of her spine and a letter from the primary team confirmed the location of the device and its leads in the sacral area.
• On admission to labour ward, thorough assessment of history, letters from the primary team & imaging.
• Epidural inserted in the L2-L3 interspace, to ensure safe distance from the device and its leads.
• Satisfactory analgesia throughout labour.
• Normal vaginal delivery.
• Nil complications during or after epidural insertion.
• SNS reactivated 6 weeks postpartum.
Discussion:
• Sacral neuromodulation is being increasingly used for the management of bladder and bowel dysfunction.
• Safety and efficacy in pregnancy and its effect on the unborn foetus? Not yet determined 1.
Thus, most patients are advised to switch off the neuromodulator during pregnancy.
Thus, most patients are advised to switch off the neuromodulator during pregnancy.
• Vaginal delivery is considered safe.
• Caesarean section should be performed only for obstetric indications.
• Epidural success rate and complications are like other pregnant patients.
• Neuraxial block has been performed successfully in many patients with a sacral nerve stimulator.
• There have been no reports of device or lead damage in patients who have had neuraxial blocks.
We, therefore, suggest that these women should be offered epidural labour analgesia as an option, should they wish, and caesarean section can be performed safely under spinal anaesthesia.
We, therefore, suggest that these women should be offered epidural labour analgesia as an option, should they wish, and caesarean section can be performed safely under spinal anaesthesia.
• SNS should be turned off prior to surgery and monopolar cautery should be used intraoperatively, as per a recent article by U Ambi et al2.
Take home messages:
• Review imaging.
• Liaise with primary team, if possible.
• Plan level of insertion accordingly.
• Scan the back to assess level of insertion, if needed.