Advertisement

Revue de médecine périnatale

, Volume 4, Issue 3, pp 99–104 | Cite as

Reste-t-il des contre-indications à l’anesthésie locorégionale en obstétrique ?

  • P. -Y. Dewandre
Article de Synthèse / Review Article

Résumé

L’anesthésie locorégionale périmédullaire (péridurale et rachianesthésie) représente la pierre angulaire de l’anesthésie et de l’analgésie obstétricale. En ce début de XXI e siècle, environ 80 % des parturientes bénéficient de ces techniques pour le travail et l’accouchement. Néanmoins, quelques rares situations représentent des contre-indications absolues ou relatives à la réalisation de ces techniques. Il convient de connaître ces situations afin non seulement de ne pas exposer nos patientes à un risque accru de complications mais également de ne pas les priver des bénéfices de ces techniques en élargissant indument le champ de ces contre-indications. Cet article passe en revue les problèmes liés au refus de la patiente, à l’infection localisée au site de ponction, à l’hypertension intracrânienne, à l’hypovolémie, aux troubles de l’hémostase héréditaires ou acquis, à l’allergie aux anesthésiques locaux, à l’hyperthermie, aux cardiopathies, aux affections neurologiques, aux anomalies du rachis, à la dilatation cervicale et aux tatouages lombaires.

Mots clés

Contre-indication Rachianesthésie Péridurale Anesthésie locorégionale 

Does it remain any contraindication to regional anaesthesia in obstetrics?

Abstract

Regional anaesthesia (epidural and spinal) is the cornerstone of obstetric anaesthesia and analgesia. In the beginning of the 21st century, about 80% of the parturient take benefits from these techniques during labour and delivery. However, very few situations represent absolute or relative contraindications to regional anaesthesia. The adequate knowledge of these contraindications prevents to expose our patients to an increased risk of complications of regional techniques but also avoid depriving them of their benefits in the name of false contraindications. This paper reviews the problems of patient refusal, site of puncture’s infection, intracranial hypertension, hypovolemia, inherited and acquired coagulopathy, allergy to local anaesthetics, hyperthermia, cardiopathy, neurological diseases, spinal abnormalities, cervical dilation and lumbar tattoo. All together, it estimated that less than 0.5% of the parturient are contraindicated to regional anaesthesia in obstetrics.

Keywords

Contraindication Spinal anaesthesia Epidural anaesthesia Regional anaesthesia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Polley LS, Glosten B (2004) Epidural and spinal analgesia/anesthesia. In: Chestnut DH (ed) Obstetric anesthesia: Principles and practice. Elsevier Mosby, Philadelphia, p 324–348Google Scholar
  2. 2.
    Brichant JF, Dewandre PY (2009) Analgésie péridurale pour le travail et l’accouchement. In: Diemunsch P, Samain E (ed) Anesthésie-réanimation obstétricale. Elsevier Masson S.A.S., Paris, p 37–54Google Scholar
  3. 3.
    Brichant JF, Dewandre PY (2009) Analgésie péridurale pour le travail et l’accouchement. In: Gauthier-Lafaye P (ed) Anesthésie locorégionale et traitement de la douleur. Elsevier Masson S.A.S. p 373–392Google Scholar
  4. 4.
    Eltzschig HK, Lieberman ES, Camann WR (2003) Regional anesthesia and analgesia for labor and delivery. N Engl J Med 348:319–332PubMedCrossRefGoogle Scholar
  5. 5.
    Anim-Somuah M, Smyth R, Howell C (2005) Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev CD000331Google Scholar
  6. 6.
    Palot M, Leymarie F, Jolly DH, Visseaux H, et al (2006) Request of epidural analgesia by women and obstetrical teams in four French areas. Part II: Management of epidural analgesia. Ann Fr Anesth Reanim 25:569–576PubMedCrossRefGoogle Scholar
  7. 7.
    Van Houwe P, Heytens L, Vercruysse P (2006) A survey of obstetric and anaesthesia practice in Flanders. Acta Anaesthesiol Belg 57:29–37PubMedGoogle Scholar
  8. 8.
    Johnson M, Zavisca F (1998) Intracranial and spinal cord lesions. In: Gambling and Douglas (Ed) Obstetric Anesthesia and Uncommon Disorders. W.D. Saunders Company. Philadelphia, p 219–237Google Scholar
  9. 9.
    Moen V, Irestedt L (2008) Neurological complications following central neuraxial blockade in obstetrics. Cur Opin Anesthesiol 21:275–280CrossRefGoogle Scholar
  10. 10.
    Ruppen W, Derry S, McQuay H, Moore A (2006) Incidence of epidural hematoma, infection and neurological injuryin obstetric patients with epidural analgesia/anesthesia. Anesthesiology 105:394–399PubMedCrossRefGoogle Scholar
  11. 11.
    Lee L, Posner K, Domino K, Caplan R, et al (2004) Injuries associated with regional anesthesia in the 1980s and 1990s. A closed claims analysis. Anesthesiology 101:143–152Google Scholar
  12. 12.
    Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockade in Sweden 1990–1999. Anesthesiology 101:950–959PubMedCrossRefGoogle Scholar
  13. 13.
    SFAR: Recommandations formalisées d’experts (2012) Examens pré-interventionnels systématiques. http://www.sfar.org/_docs/articles/v24-05-2012RFEExamenprinterventionnelstextecourt.pdf
  14. 14.
    ASA (2007) Practice guidelines for obstetric anesthesia. An updated report of the American society of anesthesiologists task force on obstetric anesthesia. Anesthesiology 106:843–863CrossRefGoogle Scholar
  15. 15.
    Belgian guidelines and recommendations for safe practice in obstetric anesthesia (2003) Acta anaesthesiol Belg 54:119–125Google Scholar
  16. 16.
    Breivik H, Bang U, Jalonen L, Vigfusson G, et al (2010) Nordic guideline for neiraxial blocksin disturbed hemostatsis from the Scandinavian society of anaesthesiology and intensive care medicine. Acta anaesthesiol Scand 54:16–41PubMedCrossRefGoogle Scholar
  17. 17.
    Tanaka M, Balki M, McLeod A, Carvalho J (2009) Regional anesthesia and non-preeclamptic thrombocytopenia: Time to rethink the safe platelet count. Rev Bras Anestesiol 59:142–153PubMedCrossRefGoogle Scholar
  18. 18.
    Thornton P, Doulas J (2010) Coagulation in pregnancy. Best pract res clin obstet gynaecol 24: 339–352PubMedCrossRefGoogle Scholar
  19. 19.
    Vandermeulen E, Decoster J, Dewandre PY, Ickx B, et al(2011) Central neural blockade in patients with drug-induced alteration of coagulation. Third edistion of the Belgian association for regional anesthesia (BARA) guidelines. ActaAnaesthesiol Belg 62:175–191Google Scholar
  20. 20.
    Santos A, Finster M (2004) Local Anesthetics. In: Chestnut DH (ed) Obstetric anesthesia: Principles and practice. Elsevier Mosby, Philadelphia, p 190–210Google Scholar
  21. 21.
    Bruyere M (2009) Cardiopathies. In: Diemunsch P, Samain E (ed) Anesthésie-réanimation obstétricale. Elsevier Masson S.A.S., Paris, p 195–207Google Scholar
  22. 22.
    The task force on the management of cardiovascular diseases during pregnancy of the European society of cardiology (ESC) (2011) ESC guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J 32:3147–3197CrossRefGoogle Scholar
  23. 23.
    Elkayam U, Bitar F (2005) Valvular heart disease and pregnancy. Part 1: Natives valves. JACC 46:223–230PubMedGoogle Scholar
  24. 24.
    Elkayam U, Bitar F (2005) Valvular heart disease and pregnancy. Part 2: Prosthetic valves. JACC 46:403–410PubMedGoogle Scholar
  25. 25.
    Bader M (2004) Neurologic and Neuromuscular Disease. In: Chestnut DH (ed) Obstetric anesthesia: Principles and practice. Elsevier Mosby, Philadelphia, p 872–891Google Scholar
  26. 26.
    Kuczkowski KM (2006) Labor analgesia for the parturient with neurological disease: what does an obstetrician need to know. Arch Gynecol Obstet 274:41–46PubMedCrossRefGoogle Scholar
  27. 27.
    Ducloy-Bouthors AS, Dalmas-Laurent AF, Richart P (2009) Maladies neurologiques. In: (ed) Anesthésie-réanimation obstétricale. Masson, Paris, p 219–227Google Scholar
  28. 28.
    Rezig K, Diar N, Benabidallah D, Khodja A, et al (2003) Paraplegia and pregnancy: anaesthetic management. Ann Fr Anesth Reanim 22:238–241PubMedCrossRefGoogle Scholar
  29. 29.
    Powell HC, Kalichman MW, Garrett RS, Myers RR (1988) Selective vulnerability of unmyelinated fiber Schwann cells in nerves exposed to local anesthetics. Lab Invest 59:271–280PubMedGoogle Scholar
  30. 30.
    Sakurai M, Mannen T, Kanazawa I, Tanabe H (1992) Lidocaine unmasks silent demyelinative lesions in multiple sclerosis. Neurology 42:2088–2093PubMedCrossRefGoogle Scholar
  31. 31.
    Crosby E (2004) Musculoskeletal Disorders. In: Chestnut DH (ed) Obstetric anesthesia: Principles and practice. Elsevier Mosby, Philadelphia, p 856–871Google Scholar
  32. 32.
    Kuczkowski KM (2007) Labor analgesia for pregnant women with spina bifida: what does an obstetrician need to know? Arch Gynecol Obstet 275:53–56PubMedCrossRefGoogle Scholar
  33. 33.
    Tidmarsh MD, May AE (1998) Epidural anaesthesia and neural tube defect. Int J Obstet Anesth 7:111–114PubMedCrossRefGoogle Scholar
  34. 34.
    Ko J, Leffert L (2009) Clinical implications of neuraxial anesthesia in parturients with scoliosis. Anesth Analg 109:1930–1934PubMedCrossRefGoogle Scholar
  35. 35.
    Wang F, Shen X, Guo X, Peng Y, et al (2009) Epidural analgesia in the latent phase of labor and the risk of caesarean delivery. Anesthesiology 111:871–880PubMedCrossRefGoogle Scholar
  36. 36.
    HalpernS, Abdallah F (2010) Effect of labor analgesia on labor outcome. Curr Opin Anesthesiol 23:317–322CrossRefGoogle Scholar
  37. 37.
    Sleth JC, Guillot B, Kluger N (2010) Lumbar tattoo and neuraxial anesthesia in obstetrics: Practice survey in Languedoc-Roussillon, France. Ann Fr Anesth Reanim 29:397–401PubMedCrossRefGoogle Scholar
  38. 38.
    Mercier FJ, Bonnet MP (2009) Tatooing and various piercing: anesthetic considerations. Curr Opin Anesthesiol 22:436–441CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2012

Authors and Affiliations

  1. 1.Service universitaire d’anesthésie-réanimation, CHU LiègeCHR de la Citadelle LiègeLiègeBelgique

Personalised recommendations