Labor epidural placement in a woman with a cervical spinal cord stimulator

A 37-year-old female, gravida 1 para 0, in active labor at term, with a cervical spinal cord stimulator in situ, presented for epidural analgesia for labor. She had received the cervical spinal cord stimulator some 30 months before, to treat chronic regional pain syndrome I. She was taking no medication, and was thin but otherwise healthy. The cervical spinal cord stimulator electrodes entered the C7-T1 interspace, and their end was in the epidural space at the C3 level. The electrodes were fixed to a cervical spinous process, crossed the midline high in the back and then went down the left side of her back parallel to her spine to the generator, which was in her buttock. The electrode cable could be felt high on the left side of her back, but not in her lumbar region. After consultation, it was felt safe and reasonable to proceed with labor epidural anesthesia. The procedure took place with the patient sitting, using a standard reusable 17-gauge Tuohy needle. Subsequent analgesia was acceptable. The patient also observed about 20 min after receiving the epidural medication that suddenly she could move her right hand more easily and that it felt warm. Her labor and delivery proceeded uneventfully. The spinal cord stimulator continued to function well throughout the entire process. She noticed that the feeling in her right hand returned to baseline after the delivery.