Transition from failed epidural labor analgesia to combined spinal–epidural anesthesia: What to do when encountering difficulties in spinal cord puncture? A case report

Although labor epidural analgesia can effectively alleviate pain during childbirth, some women may experience a decrease in the effectiveness of the initially effective epidural analgesia or a complete loss of effectiveness (disappearance of the epidural block level) during labor. For cases where the analgesic effect is insufficient after the administration of additional medication or where the epidural block level is completely lost, it is recommended to replace the epidural catheter. When reinserting the epidural catheter, combined spinal–epidural anesthesia should be considered for labor analgesia, as this combination can shorten the onset time and reduce the failure rate. However, for some women who had received epidural analgesia for a long time, due to the expansion of the epidural space caused by local anesthetics, spinal anesthesia may be challenging. Therefore, we propose the use of an extended spinal needle among these patients as a modification of the standard practice to facilitate successful spinal anesthesia.