Expert: Ronald Levy, M.D. - 7/27/2011

Question
I had my first child on 4/1 by cesarean section. After 18 hours of labor, I asked for an epidural, at which time I was given the full list of risks...sometime after beginning to place the epidural, the Anesthesiologist apologized that I was leaking cerebrospinal fluid and explained that I may experience a spinal headache. This is part one of my anesthesia nightmare. I did end up with a spinal headache, for which they did a blood patch and had to lay flat (besides sitting to breastfeed)for nearly 3 days! Prior to this,  she left the catheter in place and explained that it would remain there for 12 hours to "prevent" a spinal headache. She inserted another catheter and I was in epidural heaven for a few hours until I was brought to the OR for my daughters unrelenting late d-cels. As a NICU nurse, I was all to happy to consent to the section, picturing my baby as one of the hundreds of babies I had resuscitated in my career. In the OR, I met another Anesthesiologist. He explained that he would prefer to give me a spinal and pull both of the catheters out. I was confused, but anxious for my baby to be delivered, so I did not question his intent. In a few minutes I was able to swing my own legs around and persisted to tell the OB that I could feel the "pinching" and "no, it did not feel like pressure." They waited a few more minutes and I again told them I didn't feel right. The Anesthesiologist gave me morphine and versed and they proceeded to begin. I LOST IT! I tried to sit up, I yelled and I was able to twist and turn most of my body. Ultimately, I was given propfol and woke up 30 minutes after my baby girl was born and a dose of narcan. I have attended hundreds of births as a NICU nurse and I have never seen anything like this happen. Could you tell me, did having the two epidurals placed earlier interfere with the spinal? Why is it that I was able to feel so much during my section? Is this more common than I think? Is it possible that this may happen again to me? My husband and I have really had a hard time dealing with this and have really struggled to understand what happened. As a side note, when I asked the OB what happened, she basically denied that anything was out of the ordinary. However, the Anesthesiologist called me at home the next week to check on me and apologize for what happened. It all left me wondering what really happened. Thank you for any insight you may have.

Answer
I cannot reasonable explain what happened to you because the sequence of events makes no sense. LEt me explain what I think happened. While attempting to place the first epidural, the anesthesiologist got into the subarachnoid space. This is not unusual and is a known risk of epidurals. She placed a catheter there which SHOULD serve two purposes. One is that it MAY prevent the spinal headache but the other is that it can e used to give you  SPINAL doses of anesthetic for labor OR for section. Placing the second epidural makes no sense because the spinal should cover you and now there are 2 catheters which increases the risk of using the wrong one with the wrong dose. When you got to the OR, the new anesthesiologist either didn't trust either catheter or didn't know which to use so pulled both. At that point it probabl would have been safer to do a general anesthetic instead of another spinal but given that you got the spinal, if you were able to differentiate pain from pressure, they should have put you to sleep at that point. Now this is all speculation on my part since I am not looking at the record but this is what I think happened. The epidurals did not interfere with the spinal, I can't explain why the spinal id not work, it is exptremely uncommon and there is no reason to think it will happen again.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston