Management of severely painful uterine leiomyoma in a pregnant woman with epidural block using a subcutaneous injection port

摘要

SirPain is the most common complication of leiomyoma in pregnancy (1). Severe abdominal pain can occur if a leiomyoma undergoes degeneration, which occurs in 5-8 of leiomyomas during pregnancy (2,3)- We wish to call attention to successful severe pain management by epidural administration of a local anesthetic via a subcutaneous injection port in a 32-year-old primigravida who had degeneration of uterine leiomyomas at 23 weeks pregnancy. She had been referred to our hospital because of uncontrolled abdominal pain. On axial T2-weighted MRI imaging, two 14 x 9 cm and 11 x 8 cm intramural myomas with degeneration were detected in the right lateral and postero-inferior body of the uterus. The degree of her abdominal pain was 910 on a visual analog scale (VAS) and she had regular uterine contractions. She was treated with intravenous ritodrine hydrochloride for the preterm contractions. Acetoaminophen, codeine and even intravenous pethidinemeperidine failed to control her pain. At our pain clinic we administered local anesthesia by epidural and patient controlled analgesia (PCA) was initiated with a dose of fentanyl 6 gh and 0.25 ropivacaine 6 mLh.