Case 82: A High Total Spinal in an Obstetric Patient

Abstract

You have placed an epidural in a 30-year-old (180 lbs 5′10″, gravida 2, para 1) female in active labor. She is otherwise healthy. In her first delivery 14 months ago, the labor epidural was, according to the patient, amazing, and she had an uneventful delivery. This epidural was placed, on the first attempt, in L3/4 interspinous space using a 17 G Tuohy needle with a plastic syringe to detect loss of resistance to air. No blood or cerebrospinal fluid (CSF) were seen. A 19 G epidural catheter was easily inserted, and a 3 ml test dose with 2% lidocaine with epinephrine was negative. Approximately 5 min later, you gave a bolus injection of 0.1% bupivacaine 5 ml with fentanyl 5 microgram/ml. Within 1 min of this later dose, the patient’s leg became heavy and numb. Since you felt this was too quick, you ascertain by placing ice, on her skin, that the block is rapidly ascending to T5. She now experiences shortness of breath and labored breathing.