Failed spinal analgesia after a combined spinal epidural anaesthesia for Caesarean section

A case of failed spinal analgesia with a combined spinal epidural anaesthesia (CSE) for Caesarean section is described. The lack of desired effect following an inconspicuous spinal, epidural or combined regional anaesthesia by an experienced anaesthetist is a rare and unexpected event. Especially when repeatedly observed in one patient, one should consider modified anatomical conditions of the affected spinal regions. We discuss the differential diagnosis which consists of inherent and acquired modification of tissue, neoplasia and vascular or infectious diseases. This case also confirms that not every adverse event after spinal or extradural anaesthesia is necessarily caused by the puncture.