Neuraxial block: The case of a faulty equipment

We had a case of 37‐year‐old male planned for bilateral mesh hernioplasty for bilateral inguinal hernia. As the patient was apprehensive and postoperative analgesia was essential, a combined spinal-epidural (CSE) technique was planned. Tuohy needle of size 18 G was introduced into at L3/L4 interspace and after confirming loss of resistance (LOR) for the epidural space, high‐flow Whitacre pencil‐point spinal needle with a variable extension adapter was advanced. After confirmation of breach of the dura by the Whitacre needle and cerebrospinal fluid flow from the subarachnoid space, the anesthesiologist administered the drug. However, after that, he was not able to remove the PTSN. The needle became intractable at that position. After several unsuccessful attempts to withdraw it, the team decided to remove the whole CSE set [Figure 1] in-toto (spinal needle along with the Tuohy needle). In the intervening time, the patient began to complain of pain at the puncture site in spite of infiltration of good amount of local anesthetic in the area of procedure. It was then decided to observe the patient for a while till the effect of the subarachnoid block came. We did not attempt for the placement of epidural catheter freshly. The patient was comfortable with the onset of the effect of the drug and the surgery was done successfully under spinal anesthesia only. In the postoperative period, the patient complained of pain over the neuraxial block site after the regression of spinal drug effect, local pain over the back was managed with oral analgesics. The patient went home without further complications.

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