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Dr Gérald Kierzek (Medical Director)
On August 10, 2019, Lucie was due to give birth to her third child. Taken to a hospital in Val d’Oise, she was the victim of an epidural error and ended up in a neurovegetative state. How can such a tragedy be explained? Dr. Gérald Kierzek, an emergency physician, deciphers the potential risks and complications associated with this common procedure.
Epidurals are a form of partial anesthesia offered to pregnant women to relieve them from labor contractions. According to Inserm, 82.7% of women had recourse to them in 2021. In the vast majority of cases, this procedure leaves (fortunately!) no after-effects. So how can such a tragedy be explained?
Deprived of oxygen for 15 minutes, she ended up 98% disabled
Lucie B. went to the Simone-Veil hospital in Eaubonne (Val-d’Oise) on August 10, 2019 to give birth to her third child, a little girl. Unfortunately for her, the epidural was administered to her in the wrong place by a trainee anesthesiologist, without the supervision of a nurse. It was during this procedure that she suffered a cardiac arrest. Why? The trainee doctor pushed the needle too far when giving the epidural.
Lucie B. will subsequently undergo emergency surgery so that her child can be born by caesarean section. But her brain will be deprived of oxygen for fifteen minutes, which will cause serious after-effects. The young woman – now 40 years old – has since been declared 98% disabled and is staying in a clinic, according to our colleagues at Parisian.
His relatives are suing the hospital, they have filed a complaint for unintentional injuries with the Pontoise prosecutor. The administrative court has also been notified and the expert doctors, appointed by the Île-de-France medical accident conciliation and compensation commission (CCI), acknowledge a medical error.
Asked about this case, Dr. Gérald Kierzek, emergency physician and medical director of Doctissimo, first recalls that the “Epidural is considered a safe and effective technique for relieving pain during childbirth.“.
However, complications can arise, such as:
- A drop in blood pressure;
- Headaches (in case of accidental perforation of the dura mater, one of the layers of the meninges surrounding the brain and spinal cord);
- Temporary lower back pain;
- And in extremely rare cases, neurological complications such as temporary paralysis or sensory disturbances.
What is the difference between epidural and spinal anesthesia?
By pushing the needle too far, the trainee doctor therefore performed spinal anesthesia instead of an epidural.”The main difference between epidural and spinal anesthesia is the injection site of the anesthetic.” defines Gerald Kierzek.
“Epidurals involve injecting the anesthetic into the epidural space, located just outside the covering of the spinal cord, via a catheter that allows for repeated injections and dose adjustment. Spinal anesthesia, on the other hand, involves direct injection into the cerebrospinal fluid surrounding the spinal cordwhich produces a faster and more intense effect, but of limited duration and without the possibility of adjustment.”
In this patient’s case, because of this injection in the wrong place, because the catheter is inserted too far, “The risk was respiratory paralysis in particular and cardiac arrest if poor monitoring and immediate intubation were not performed” adds Dr Gérald Kierzek. “Similarly, in the event of respiratory arrest due to paralysis, intubation can prevent cardiac arrest. However, constant monitoring is still required…” qualifies the doctor. Which does not seem to have been the case for Lucie B.
An accident that should not have happened
In fact, this accident should never have happened. “Theoretically, a test dose of anesthetic is injected when the epidural catheter is put in place, to check for complications… and before injecting more doses!” recalls the emergency doctor.
“According to experts, there were several mistakes” concludes Gérald Kierzek.”A bad injection site, with spinal anesthesia instead of an epidural, no test dose injected and a lack of monitoring until cardiac arrest, resuscitated but with serious after-effects, due to lack of oxygen to the brain.”
The rate of epidurals during childbirth in France is among the highest in the world, with more than eight out of ten women receiving one. This isolated incident should not call into question the use of this technique. According to this recent study, published in the British Medical Journalthis procedure could even reduce the risk of serious complications by 35%.