Successful Vaginal Delivery Enabled by Continuous Epidural Analgesia for Cancer-Related Pain in Pregnancy: A Case...

Managing cancer-related pain during pregnancy presents a significant clinical challenge due to the limited use of systemic analgesics, such as opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), owing to the potential risks to the fetus. Severe cancer-related pain may impair a parturient's ability to assume or maintain an optimal labor positioning during labor and delivery, potentially precluding vaginal delivery. In June 2019, a 32-year-old pregnant woman with synovial sarcoma developed intractable gluteal pain that impaired her ability to assume an appropriate delivery position. Given the concerns regarding the use of systemic opioids and NSAIDs, continuous lumbar epidural analgesia was initiated at 34 weeks' gestation to manage cancer-related pain. This approach enabled the patient to tolerate labor positioning, leading to successful vaginal delivery with minimal discomfort. Postpartum pain was managed with oral opioids, and definitive oncologic treatment was initiated one month after delivery. This case demonstrates that continuous epidural analgesia can serve as an effective and safe strategy to manage cancer-related pain during pregnancy, facilitating vaginal delivery when systemic analgesic use is limited.