A 26-year-old woman sustained accidental total spinal block following induction of epidural analgesia for labour, despite conventional precautions for prevention of this complication. Unusual features included slow onset of block, only slight hypotension, the need for a muscle relaxant drug to assist with intubation, and only a brief period of unconsciousness. Possible mechanisms include massive subarachnoid block, subdural block, and massive epidural block. This case demonstrates that conventional precautions do not preclude accidental total spinal anaesthesia, and that drugs, equipment, and an anaesthetist must be readily available in all areas where epidural analgesia is in progress.
