A case of extensive block with the combined spinal-epidural technique during labour

The increasing use of combined spinal-epidural analgesia in obstetric pract ice has arisen from a desire to achieve a rapid onset of analgesia while re ducing the intensity of the motor block. Although the procedure has an exce llent safety profile, as with any technique there are potential problems. D ifficulty in assessing the position of the epidural catheter after establis hment of the spinal blockade may lead to an abnormally extensive block when a full-strength local anaesthetic solution is used. We present a case in w hich the use of 0.5% bupivacaine to top-up the epidural component of a comb ined spinal-epidural resulted in a total spinal block. The possible causes of this complication are discussed.