Combined spinal and epidural analgesia in a parturient with severe myasthenia gravis

Background and Objectives . A 27-year-old woman with a history of myasthenia gravis presented for vaginal delivery. Methods . A combined spinal epidural was initiated with 7.5 μg intrathecal sufentanil at the time of first request for analgesia followed by 140 mg epidural lidocaine prior to spontaneous vaginal delivery. Results . The patient had a pain-free spontaneous vaginal delivery uncomplicated by muscle weakness. Conclusion . Combined spinal and epidural anesthesia using intrathecal opioids initially provides labor analgesia with minimal muscle weakness in the parturient with myasthenia gravis.