Waikato woman's epidural complication 'as rare as rare as rare'

A Hamilton mother-of-four's six month battle with insufferable pain after an epidural appears to be one of the rarest cases of its type in New Zealand and possibly the world.

Clare Hutchinson has likened the pain from the May 31 incident to that of someone drilling a pencil into her spine.

Waikato Hospital lead obstetric anaesthetist Aidan O'Donnell says it is "phenomenally rare" for women to suffer any longstanding injury from an epidural and in some cases the injection can help save lives.

Medical staff have been left scratching their heads after exhausting all of the usual tests, scans and X-rays to pinpoint exactly what's going wrong in Hutchinson's body.

Hutchinson told the Herald she was given the epidural during the birth of her daughter, which eventually occurred naturally.

The next day she developed serious headaches and after the third day she was given the option of having a blood patch procedure - a straightforward operation where blood is taken from the patient's arm and injected into the hole in the spine - to patch up the hole in the spinal cavity.

While in most - 75 per cent - of cases the pain dissipates, it remained for Hutchinson.

"[The injection] hit some nerves so by day five I certainly noticed that. I had an afternoon sleep and went to get up and while I could get up, I felt like I had a dead leg, like I had been Charlie'd on the thigh."

The 32-year-old went to feed her now 6-month-old daughter, Natalie, and could only get one of her legs on to her chair.

"Since then it's just been an ongoing process of strong painkillers because it always feels like there's a pencil being drilled into my spine. I can't sleep in my bed, I have been on the couch for the past six months."

She had since suffered further serious incidents including one where her legs stiffened up and she couldn't move, which required her to be hospitalised for a month.

She can't drive either but is thankful her mother can help out in the mornings getting the children ready for school as her husband works more than 12-hour days in his job as a welder. She also uses her wheelchair on public outings as well as a walker to help get around the house.

As for whether she can walk, Hutchinson likens her gait to that of a zombie.

"I can shuffle round the house like a zombie. I have one leg that feels like it's concrete so I kind of drag it behind. I would be a great extra in a zombie movie."

However, she misses doing the usual "motherly stuff" like picking up her children for a cuddle or bending over and kissing them goodnight in bed.

Despite her predicament, she doesn't hold a grudge against hospital staff.

O'Donnell said there were approximately 3500 babies delivered at Waikato Hospital each year. Of those births, 27 per cent, or 1000, required an epidural.

He says the most thorough study carried out on complications due to epidurals was done by the Royal College of Anaesthetists in the United Kingdom and dubbed the NAP3 Study - The National Audit Project 3 Study.

It stated the frequency of a woman suffering a permanent injury was equivalent to 1 in 24,000 and 1 in 54,000 cases respectively.

"So if we do 1000 [epidurals] a year, that means one woman every 24-54 years will be injured in our hospital permanently by an epidural or spinal epidural. So as rare as rare as rare. Phenomenally rare."

O'Donnell said he has not heard of a case of a woman suffering permanent injury from an epidural at Waikato Hospital before.

After looking at her clinical notes, he said there was nothing to suggest that "this was anything other than what normally happens".

"Which is an anaesthetist trying to do their best for a woman who is in labour and sore and maybe can't keep still and it's a fiddly job at the best of times and maybe didn't get the needle in the right space."

O'Donnell said Hutchinson's condition was so rare that they can't recognise it on a scan, which made it "impossible to say what it is and impossible to say if it's going to get better".

"What we can say is that we have ruled out 99.5 per cent of what it could be like cancer, meningitis, nerve compression, collapsed vertebrae, abscesses or haematomas, and we're left looking at normal scans and a suffering patient and we're scratching our heads."

Although Hutchinson is booked in to see the anaesthetist team again soon, he added he wasn't sure if further tests would help as they weren't sure what they were looking for.

WHAT IS AN EPIDURAL?

• An anaesthetist puts a needle into the space around the spinal cord - which is called the epidural space - in between the L3 and L4 vertebrae.
• Once the needle is in, a very fine plastic tube- epidural catheter - is inserted down through the needle and into the epidural space.
• Once in, the needle is taken out, the catheter stays in, and a mixture of anaesthetic medications is injected into the epidural space.
• However, on 1 per cent of occasions, a needle can be inserted too far puncturing the membrane around the spinal cord - called 'the dura' - and that's why it's called the epidural space.
• In the dura is cerebrospinal fluid [CFS]- a clear fluid that surrounds the spinal cord and the brain.
• If CSF leaks, it trickles into the epidural space creating "the most incredible headaches".