Recent OB I did -- 5'3'', 28 yo primip. Healthy, 164#. I notice mild scoliosis in lumbar area, right hip is a little higher, right shoulder a little lower, lumbar area seems to have a gentle curve to the left. Epidural placed with puncture mid-line by palpation of spinous processes, found good ligament by angling a little to left, excellent loss of resistance at about 4cm needle depth, catheter threaded 5 cm without resistance. No heme, no fluid, no paresthesia. 3cc test dose 1.5% lido with epi. No signs of IV dose, no numbness of feet or butt. But, before I get her laid back down, she is smiling at me and saying how much better she feels. I test with an alchohol swab and she has a level at t-10. 2cc fent, and total of 6 more cc of .2% ropiv and she is very comfortable with a t-6 level. I put her on an infusion of .1%ropiv with 2mcg/cc fent at 8 cc/hr, and 45 minutes later, she has a t3 level with numb nipples and pinkies.

My question -- when I thought about it, I seem to remember other pts with mild scoliosis getting better levels with lower doses than I would anticipate from experience. Have others encountered this, or seen any literature concerning epidurals in pts with mild scoliosis? I would generally expect a pt this size to require about a 10-12cc bolus after the test dose, and to tolerate 8-10cc per hour of infusion.

Thanks,
Paul