Low dose spinal anaesthesia and transversus abdominis plane block in a parturient with peripartum cardiomyopathy for caesarean section following a bloody epidural tap

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy which presents unique challenges for anaesthetic management. Here we present a case of PPCM who was given low dose spinal anaesthesia with TAP block for caesarean section which is rarely reported. A 33-year-old multigravida, 35 weeks gestation presented with PPCM with ejection fraction of 24%. Elective caesarean section was planned in view of worsening dyspnoea despite treatment. Graded epidural anaesthesia with invasive monitoring was planned but we encountered a bloody tap whilst securing the epidural catheter, hence switched to low dose spinal anaesthesia (6mg of 0.5% bupivacaine+10mcg of fentanyl). Ultrasound guided bilateral TAP block was given for post-operative analgesia. We observed that the patient had a comfortable and haemodynamically stable experience intra and post operatively. Hence a low dose spinal anaesthesia and TAP block with invasive monitoring can be opted as an anaesthetic technique in PPCM.