Expert: Ronald Levy, M.D. - 6/18/2008

Question
QUESTION: What is the maximum amount of attempts to place an epidural catheter that would be considered safe and in good practice?  My anesthesiologist put the needle in and out over 25 times, and something is wrong with my back now.

ANSWER: There is no maximum although most anesthesiologists would give up after 5 or 6 tries. I find it hard to believe he tried 25 times (i.e. 25 separate needle sticks). The question is why was he so insistant to get an epidural and not some other anesthetic technique?

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: It was a very weird situation indeed.  I was in labor for over 20 hours, and tried to have a natural birth. When I finally decided to go with the epidural, he placed the intrathecal epidural with success and i was pain free. He said that usually he would wait two hours and see how I was doing but that he had a c-section to attend to and would be back in 45 minutes.  He came back and started to try to get the catheter in. He sat there for over 45 minutes and just kept sticking the needle in and out over and over.  My mother was there and asked him why he was doing it so many times. He seemed very nervous and anxious.  It was like he wanted to get it in so bad that he didnt even think about what he was doing. At one point he actually left, I thought he was going to get help.  But he came back and kept poking in the same spot about 5 more times. There was blood dripping down my back, and he was dipping the needle into sterilization fluid with blood in it.  The only reason I know for a fact that he made over 25 attempts is because that is how many hole marks were in my back the next day.  I am sure it was much more than that, as he kept trying in the same spots as well.  Finally, after all of this, he moved up my back about 5 inches, made about 5 attempts there and put it in. It was one of the worse experiences of my life.  And now I have been in chronic back pain ever since, with numbness, tingling, knife like stabbing pains, and many more pain symptoms. I dont know where to go for help, as the doctors i have been to so far seem leary to even help me. Have you ever heard of an anesthesiologist doing something like this?  What kind of damage could have been done? Don't they teach you in med school that something like this could be dangerous?  Thank you so much for your help or any information you can give me.  My life has changed for the worse since this incident.  Thank you.

ANSWER: I am sorry for the bad experience you had and it certainly seems like this anesthesiologist did not do the right thing. First of all, if he was going to give you an intrathecal injection, he could have done a combine spinal/epidural and only stuck you once. As for 25 sticks in the same place, this is unheard of. Usually when it doesn't go in after 2 or 3 attempts, we change levels. I am sure that in those multiple attempts he kept scrapping and injuring the ligaments at that level. You should see a neurosurgeon or orthopedic surgeon to let them work up your back pain. This may just be a temporary thing but it should be seen. As for med school, they don't need to teach that as it is common sense that you don't keep trying something that doesn't work! Please don't have a negative opinion of anesthesiologist becuase of this incident. Most of us are carin, compassionate individuals who try to do our best for our patients.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Thank you so much! One more thing, I have been told to see a pain management doctor, which from my understanding are also anesthesiologists.  I am afraid they will ignore my story, as a few other doctors have. Should I just go to the neurosurgeon or orthopedic surgeon, or also/just a pain man. specialist? I see that you avoid pain man. questions.  I just don't know if they could help me. I am leary of seeing another anesthesiologist.  Although I have talked to many, many people and this story is very rare. Thank you for your help. You dont know how much it means to me! : ) Oh, also, have you ever heard of arachnoiditis or epidural fibrosis? These I have researched and seem like possibilities.  I have had MRI's and nothing has shown up but that doesnt mean there isnt something wrong, right?

Answer
I avoid pain management questions because I am not a specialist in this area but I highly recommend pain management specialists to patients who need their service and you are one of them. They will not ignore your story, in fact they will likely be more sympathetic to it. You should probably see both (but start with the pain management people first). I have heard of both conditions. I doubt you have the first but the second is possible. The pain management people will give you a better handle on that.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston