Epidural Placement Challenges in the Setting of Spinal Fusion

 We present this case to discuss the challenges of neuraxial anesthesia for patients with a history of spine surgery. Previous spinal interventions can cause ligamentum flavum hypertrophy,  spinal scarring, and narrowing of the epidural space due to obstruction by hardware or osseous changes. These anatomical variations increase the risk of unintentional dural puncture, false loss of resistance, and may lead to an inability to thread an epidural catheter.

   This case aims to discuss the preoperative management, methods of troubleshooting difficult epidural placement, and alternative labor analgesia strategies, pharmacologic and nonpharmacologic for patients with complex spinal anatomy. Although studies have shown that the success rate of neuraxial following spinal surgery is 85-95%, with only 50-60% analgesic efficacy, physicians can optimize the tools available to ensure analgesic success.