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 mu g 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.