Thoracolumbar labour epidural analgesia in a parturient with permanent gluteal silicone-like biopolymer infiltration

Abstract

Gluteal augmentation procedures with permanent soft tissue fillers, including liquid silicone and silicone-like biopolymers, are widely used. These procedures may be undertaken in settings without strict regulatory oversight. Unlike resorbable materials, permanent fillers can migrate along fascial planes and induce chronic inflammatory reactions, fibrosis and granulomatous reactions, potentially altering normal anatomical structures years after injection. Cranial migration into paraspinal soft tissues has been reported, causing concern regarding neuraxial access, although the implications for neuraxial anaesthesia are unclear. The presence of foreign material in the lumbar region is regarded as a relative or absolute contraindication to epidural or spinal techniques, even in the absence of radiological evidence of epidural space involvement. The key learning points in our case lie in the presence of extensive permanent silicone infiltration within the gluteal and lower lumbar soft tissues and in the anatomical assessment and clinical decision-making informed by radiology investigations. We report a case of a parturient with documented permanent gluteal silicone infiltration who had previously been considered unsuitable for neuraxial labour analgesia. Radiological re-assessment enabled the identification of a safe thoracolumbar approach to labour epidural analgesia.