Patient-controlled epidural analgesia in a parturient with hypertrophic obstructive cardiomyopathy

We describe the use of patient-controlled epidural analgesia (PCEA) using fentanyl in the management of a labouring parturient with hypertrophic obstructive cardiomyopathy (HOCM). With non-invasive monitoring, PCEA was started in the early first stage of labour with a bolus dose of fentanyl 20 microg, lockout 5 min and 4-h maximum dose of 500 microg. Analgesia was satisfactory during the early first stage but was poor subsequently, despite a total fentanyl consumption of 760 microg during the 6-h labour. The maternal cardiovascular condition was stable throughout labour and delivery and the baby was born in good condition without subsequent respiratory depression. Opioid-based PCEA is an alternative to systemic analgesia in labouring parturients with HOCM. However, although its use avoids the potential adverse effects of sympathetic block associated with conventional epidural analgesia, our regimen had limited analgesic efficacy in the latter stage of labour.