Multimodal anesthesia option in a pregnant woman undergoing lumbar microdiscectomy: a clinical case.



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Abstract

Spinal surgery during pregnancy is rare and lacks standardized protocols. This paper presents a case of a pregnant patient at 14 weeks requiring microdiscectomy for a disc herniation refractory to conservative treatment. A key anesthetic strategy was the use of a combined technique: a preoperative TLIP block for regional analgesia performed after induction of general anesthesia maintained with sevoflurane, fentanyl, and rocuronium, while strictly avoiding NSAIDs. The procedure was uneventful, with excellent pain control, minimal systemic opioids, and stable maternal and fetal outcomes. This experience suggests that the combination of a TLIP block and balanced general anesthesia is a promising approach for minimizing pharmacological burden and ensuring safety in such complex cases.

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About the authors

Artem V. Oskolkov Oskolkov

Clinical Hospital Lapino "Mother and Child"

Author for correspondence.
Email: art.oskolkov2017@yandex.ru
ORCID iD: 0000-0002-3550-9881
SPIN-code: 8530-5119
Russian Federation

Vadim N. Rashidov

Email: v.rashidov@mcclinics.ru

Vadim E. Gruzdev

Email: vadimgru@yandex.ru

Renat L. Kambiev

Email: 1606936@mail.ru

References

  1. Butenschoen VM, Hitscherich H, Eicker SO, et al. Spine surgery in pregnant women: a multicenter case series and proposition of treatment algorithm. Eur Spine J. 2021;30(4):809-817. doi: 10.1007/s00586-020-06683-2
  2. Kapetanakis S, Giovannopoulou E, Blontzos N, Kazakos G, Givissis P. Surgical management for lumbar disc herniation in pregnancy. J Gynecol Obstet Hum Reprod. 2017;46(10):753-759. doi: 10.1016/j.jogoh.2017.08.006 ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019;133(4):e285-e286. doi: 10.1097/AOG.0000000000003174
  3. Bleeser T, Vally JC, Van de Velde M, Rex S, Devroe S. General anaesthesia for nonobstetric surgery during pregnancy: A narrative review. Eur J Anaesthesiol Intensive Care. 2022;1(2):e003. doi: 10.1097/EA9.0000000000000003
  4. Chandra M, Paray AA. Natural Physiological Changes During Pregnancy. Yale J Biol Med. 2024;97(1):85-92.
  5. Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med. 2011;32(1):1-13. doi: 10.1016/j.ccm.2010.11.001
  6. Hussein A, Quiceno E, Pacheco-Barrios N, et al. Lumbar Disc Herniation and Cauda Equina Syndrome During Pregnancy: A Systematic Review. Acta Neurochir (Wien). 2024;166(1):479. doi: 10.1007/s00701-024-06155-2
  7. Ofori B, Oraichi D, Blais L, Rey E, Bérard A. Risk of congenital anomalies in pregnant users of non-steroidal anti-inflammatory drugs: A nested case-control study. Birth Defects Res B Dev Reprod Toxicol. 2006;77(4):268-279. doi: 10.1002/bdrb.20085
  8. Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y. Low-back pain in pregnancy. Spine (Phila Pa 1976). 1987;12(4):368-371. doi: 10.1097/00007632-198705000-00011
  9. LaBan MM, Perrin JC, Latimer FR. Pregnancy and the herniated lumbar disc. Arch Phys Med Rehabil. 1983;64(7):319-321.
  10. Han IH, Kuh SU, Kim JH, et al. Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases. Spine (Phila Pa 1976). 2008;33(17):E614-E619. doi: 10.1097/BRS.0b013e31817c4d8d
  11. Cohen-Gadol AA, Friedman JA, Friedman JD, Tubbs RS, Munis JR, Meyer FB. Neurosurgical management of intracranial lesions in the pregnant patient: a 36-year institutional experience and review of the literature. J Neurosurg. 2009;111(6):1150-1157. doi: 10.3171/2009.3.JNS081450
  12. Buren MA, Cil H. Anesthetic Considerations and Management of Spine Surgery Performed Under Neuraxial Anesthesia. Curr Anesthesiol Rep. 2025;15:28. doi: 10.1007/s40140-024-00671-8
  13. Iyilikçi L, Erbayraktar S, Tural AN, Celik M, Sannav S. Anesthetic management of lumbar discectomy in a pregnant patient. J Anesth. 2004;18(1):45-47. doi: 10.1007/s00540-003-0207-3
  14. Kathirgamanathan A, Jardine AD, Levy DM, Grevitt MP. Lumbar disc surgery in the third trimester--with the fetus in utero. Int J Obstet Anesth. 2006;15(2):181-182. doi: 10.1016/j.ijoa.2005.10.006
  15. Kovári VZ, Horváth L. Surgical management of cauda syndrome in the third trimester of pregnancy focusing on spinal anesthesia and right lateral positioning during surgery as possible practices. Eur Spine J. 2018;27(Suppl 3):483-488. doi: 10.1007/s00586-018-5498-z
  16. Licina A, Silvers A. Perioperative Multimodal Analgesia for Adults Undergoing Surgery of the Spine-A Systematic Review and Meta-Analysis of Three or More Modalities. World Neurosurg. 2022;163:11-23. doi: 10.1016/j.wneu.2022.03.098
  17. Lee J, Bae D, Choi W, Cho C, Bang Y, Yoo J. Effects of Sevoflurane Exposure on Fetal Brain Development Using Cerebral Organoids. J Mol Neurosci. 2022;72(12):2440-2450. doi: 10.1007/s12031-022-02080-0
  18. Abouleish E, Abboud T, Lechevalier T, Zhu J, Chalian A, Alford K. Rocuronium (Org 9426) for caesarean section. Br J Anaesth. 1994;73(3):336-341. doi: 10.1093/bja/73.3.336
  19. Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107 Suppl 1:i72-i78. doi: 10.1093/bja/aer343
  20. Mushambi MC, Athanassoglou V, Kinsella SM. Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations. Anaesthesia. 2020;75(7):945-961. doi: 10.1111/anae.15056
  21. Hand WR, Taylor JM, Harvey NR, et al. Thoracolumbar interfascial plane (TLIP) block: a pilot study in volunteers. Can J Anaesth. 2015;62(11):1196-1200. doi: 10.1007/s12630-015-0431-y
  22. Ahiskalioglu A, Yayik AM, Alici HA. Ultrasound-guided lateral thoracolumbar interfascial plane (TLIP) block: Description of new modified technique. J Clin Anesth. 2017;40:62. doi: 10.1016/j.jclinane.2017.04.015
  23. Sharma P, Kulkarni M, Gandotra A. Intra-dural intercommunications between dorsal roots of adjacent spinal nerves and their clinical significance. Surg Radiol Anat. 2021;43(9):1519-1526. doi: 10.1007/s00276-021-02761-2
  24. Zhang Z, Liu J, Xu Y, et al. Anatomical study and clinical significance of the posterior ramus of the spinal nerve of the lumbar spine. Front Cell Dev Biol. 2022;10:1019309. doi: 10.3389/fcell.2022.1019309
  25. Sanjanwala AR, Lim G, Krans EE. Opioids and Opioid Use Disorder in Pregnancy. Obstet Gynecol Clin North Am. 2023;50(1):229-240. doi: 10.1016/j.ogc.2022.10.015
  26. Kahveci K, Doger C, Ornek D, Gokcinar D, Aydemir S, Ozay R. Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery. Neurol Neurochir Pol. 2014;48(3):167-173. doi: 10.1016/j.pjnns.2014.05.005
  27. Govindappagari S, Grossman TB, Dayal AK, Grosberg BM, Vollbracht S, Robbins MS. Peripheral Nerve Blocks in the Treatment of Migraine in Pregnancy. Obstet Gynecol. 2014;124(6):1169-1174. doi: 10.1097/AOG.0000000000000556
  28. Yalın O, Uludüz D, Özge A. Peripheral nerve blocks for the treatment of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) during pregnancy. Agri. 2018;30(1):28-30. doi: 10.5505/agri.2017.33353
  29. Turan D, Arıkan F, Epözdemir S, Ozkan S. Case Report: Peripheral Nerve Block in a Pregnant Patient. Anesthesiol Pain Med. 2021;11(2):e113372. doi: 10.5812/aapm.113372
  30. De Valle MK, Adkison M, Maredia R, Stevenson C, Murugan S. Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis. Cureus. 2024;16(9):e69215. Published 2024 Sep 11. doi: 10.7759/cureus.69215
  31. Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017. Reg Anesth Pain Med. 2018;43(2):113-123. doi: 10.1097/AAP.0000000000000720
  32. Bongetta D, Versace A, De Pirro A, et al. Positioning issues of spinal surgery during pregnancy. World Neurosurg. 2020;138:471-474. doi: 10.1016/j.wneu.2020.03.111
  33. Kiefer R, Ploppa A, Dieterich HJ. [Aortocaval compression syndrome]. Anaesthesist. 2003;52(11):1073-1083. doi: 10.1007/s00101-003-0584-x
  34. Kuczkowski KM, Strock D. Large ovarian cyst as a cause of aortocaval compression. Anaesthesia. 2004;59(9):924. doi: 10.1111/j.1365-2044.2004.03924.x
  35. Chestnut DH. The Aortocaval Compression Conundrum. Anesth Analg. 2017;125(6): 1975-1977. doi: 10.1213/ANE.0000000000002565
  36. Li S, Chen X, Lin X. Refractory hypotension under neuraxial anesthesia for cesarean delivery. Chin Med J (Engl). 2019;132(12):1509-1511. doi: 10.1097/CM9.0000000000000278
  37. Lee AJ, Landau R. Aortocaval Compression Syndrome: Time to Revisit Certain Dogmas. Anesth Analg. 2017;125(6):1975-1985. doi: 10.1213/ANE.0000000000002564

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