Breakthrough labor pain, defined as the return of pain despite ongoing administration of neuraxial analgesia, poses a significant challenge within the field of obstetric anesthesia. Epidural adjunct medications may be used to enhance neuraxial block density or provide coverage to previously spared regions. Dexmedetomidine, a US Food and Drug Administration–approved selective alpha-2 adrenergic agonist, has gained attention for an off-label use as a labor epidural adjunct medication for labor analgesia. This case series highlights three cases of epidural dexmedetomidine use for breakthrough pain during labor.

Hydrophilic polymer embolism (HPE) is a rare complication of endovascular procedures caused by embolization of polymer coatings from vascular devices. We report a 72-year-old man with peripheral artery disease, diabetes, and chronic kidney disease who developed painful, nonhealing lower-extremity ulcers presenting shortly after vascular stenting. Initial biopsies and an extensive infectious and autoimmune workup were nondiagnostic, and the patient failed treatment for presumed pyoderma gangrenosum. Repeat biopsies later revealed amorphous blue material in dermal vessels, highlighted by Alcian blue staining, confirming HPE. Despite treatment with pentoxifylline and wound care, disease progression led to bilateral below-the-knee amputations. This case highlights the diagnostic challenge of HPE, which can present months after endovascular intervention and mimic other ulcerative disorders. Histologic findings are subtle, and early coordination with dermatopathology is key. Clinicians should maintain high suspicion for HPE in patients with unexplained ulcers and vascular procedure history, as early recognition may reduce morbidity.