Unusual Response to Neuraxial Anesthesia

Document Type

Conference Proceeding

Publication Date



Our patient is a 28-year-old-female G2P1001 presenting for repeat c-section. Upon reviewing anesthetic records, we noticed her spinal anesthetic did not achieve an adequate level during her previous c-section and an epidural was then placed to proceed. For this repeat c-section, we decided on a combined-spinal-epidural with intrathecal dosing of local anesthetic and opioids. Once again, an adequate level could not be achieved with our intrathecal dose and we titrated the epidural to achieve a sufficient level. In this case study, we will discuss the mechanism of action of local anesthetics and common reasons for failure of neuraxial anesthesia.


American Society of Anesthesiologists Annual Meeting, October 12-16, 2023, San Francisco, CA