Pain Management During Labor and Delivery in a Patient with Possible Local Anesthetic Resistance: A Case Report
Aksana Aliakseyeva1, *, Dante Villarreal2, Natalia Pawlowicz3
Identifiers and Pagination:Year: 2022
E-location ID: e258964582208180
Publisher ID: e258964582208180
Article History:Received Date: 16/3/2022
Revision Received Date: 30/5/2022
Acceptance Date: 30/6/2022
Electronic publication date: 31/10/2022
Collection year: 2022
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Local anesthetic resistance is a clinical entity characterized by inadequate analgesia despite technically well-performed procedures. The exact etiology and pathogenesis of this condition are not yet fully understood.
A 36-year-old Caucasian female presented to labor and delivery for induction of labor. On admission, the patient reported failure of epidural anesthesia during the previous delivery. An epidural catheter was placed, and analgesia was reported only at high doses of local anesthetic. The patient’s maximum pain level during delivery never reached a score of 2 out of 10.
The most common causes of regional anesthetic failure are technical or placement failure, failure related to the local anesthetic itself, or localized infection. This patient appeared to have a true local anesthetic resistance, which was overcome by doubling the customary concentration of local anesthetic. Atypical responses to local anesthetics observed in the patient may be due to incomplete penetrance mutations in sodium channels since local anesthetics work through blocking nerve conduction by acting on these channels.