ESRA19-0347 Charcot-marie-tooth and analgesia for labor- case report

Background and aims Charcot-Marie-Tooth disease (CMT) is a demyelinating polyneuropathy of hereditary character that produces distal weakness, muscle atrophy and sensory loss. We present a case of presumable CMT that underwent epidural analgesia during labor and delivery. Methods A 37-year-old woman, ASA III, presented at approximately 40 weeks’ gestation and was admitted to the emergency unit in labor. The patient had a family history of CMT, father and cousin, but without a diagnosis of the disease (genetic test). During physical examination, we noticed bone deformity in the left foot, decreased muscle strength, numbness and tingling in the lower limbs, which worsened during pregnancy. After the pregnant woman expressed desire for regional pain management, she was informed and accepted the risks of performing the neuroaxis approach; given the possibility of CMT disease, we opted for epidural analgesia. The technique went on without complications. Results In the 6 following hours there was no motor blockage of any grade and T8 sensitive blockade was established, providing effective analgesia. The vaginal delivery was not instrumented and went on without complications. There was complete recovery of the sensory block after 2 hours. Conclusions Taking into account that the literature on the epidural technique to labor analgesia in a patient with CMT is scarce, we think it could represent a safe option and alternative, especially considering the main causes of maternal morbidity and mortality, like failures in orotracheal intubation and higher probability of bronchoaspiration, associated in particular with general anesthesia, if anesthesia is necessary.